Randolph J Cordle escribi=F3:
> I am interested in the group's response to the following statements reg=
> the work-up of a possible urine infection in children. For the purpose=
> this discussion assume UA is just old fashioned microscopy without Gram=
> stain or hemocytometer evaluation.
> 1. All urine specimens for culture in children under 2 years of age sh=
> be collected by catheter or suprapubic tap.
> - If you would change the age let me know this as well.
* I think that urine specimens should be collected by catheter or suprapu=
bic tap in those
children with high likelihood of UTI (infants under 3 months of age or ch=
idren with urinary tract
abnormalities) and in thouse we are going to treat with antibiotics or wh=
o present UA
abnormalities in bag specimens.
> 2. In children being worked up for a possible occult urinary tract
> infection, bag specimens are only possibly helpful if the UA is negativ=
> culture grows less than 100,000 colonies of a single organism. Bag spe=
> with a positive UA should be discarded and a catheterization or suprapu=
> tap performed for collection of urine for culture.
*Yes, it's the only way to know that culture is truly positive (UTI or as=
> 3. Any child under 2 years old with a fever of undetermined etiology s=
> have a urine culture sent regardless of the UA or dip urine result.
*Always if they are ill or we are going to treat them with antibiotics. I=
n other cases it depends
on age, gender, height an duration of temperature, presence of urinary tr=
act abnormalities, etc.
> 4. Any child under 2 years old with fever of undetermined etiology sho=
> have a urine culture sent if one is going to treat them with antibiotic=
*Yes, see above
> 5. A healthy appearing fully immunized 6 month old infant with no past
> medical history, no respiratory complaints or findings, and a new fever=
> 102 degrees Fahrenheit may be safely sent home without antibiotics if t=
> appropriate work-up is normal and the social/follow-up situation allows.
*I think so
> 6. In number 5, which of the following constitute an appropriate work-=
> A. Urine Culture
> B. Blood Culture
> C. CBC with differential
> D. Lumbar Puncture
> E. Bacterial antigen screen on collected fluids (urine, blood, CSF)
> F. CXR
*In a looking well infant it's possible a good management without laborat=
ory work-up except UA.
CXR could be delayed if there is not respiratory symptoms.
Javier Benito, MD
Hospital de Cruces, Bilbao, Spain.
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