In the June 1999 essay that comes with Emergency Medical Abstracts,
Richard Bukata suggests an approach to the diagnosis of an UTI in
febrile pre-verbal children, who have no apparent source for the fever.
He bases his argument on an article by Alejandro Hoberman and Ellen Wald
(Ped Infect Dis J 16 (1) January 1999).
First, he states that a bagged urine specimen is unacceptable. He states
that a catherized urine specimen must be obtained. Do you agree?
Secondly, he states that simply doing an urine dipstick on the
catherised urine specimen has too low a sensitivity and that a
combination of an enhanced urinalysis (> 10 WBC per high power field on
uncentrifuged urine) + gram stain of unspun urine (any bacteriae seen in
10 high power fields) is required. If the combination is positive => can
presumptively treat for an UTI. If only one test is positive => culture
the urine and do not treat while awaiting for the C&S results. Do you
agree with this approach?
He suggests yet another approach if gram staining is not performed. He
suggests culturing the urine in any child that has pyuria or pyuria +
bacteriuria and presumptively treating the child with antibiotics
pending urine C&S results. If only bacteriuria is present (without
pyuria) he suggests a repeat enhanced urinalysis in 24 hours. If pyuria
present => give antibiotics. If still no pyuria => diagnosis =
asymptomatic bacteriuria and antibiotic treatment is not initiated. Do
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