Subject: UTI evaluation in children
> I am interested in the group's response to the following statements
> the work-up of a possible urine infection in children. For the purpose of
> this discussion assume UA is just old fashioned microscopy without Gram's
> stain or hemocytometer evaluation.
> 1. All urine specimens for culture in children under 2 years of age
> be collected by catheter or suprapubic tap.
> If you would change the age let me know this as well....
..I prefer "toilet trained" as my cut offf for catheter/SPU vs. CC
> 2. In children being worked up for a possible occult urinary tract
> infection, bag specimens are only possibly helpful if the UA is negative
> culture grows less than 100,000 colonies of a single organism. Bag
specimens with a positive UA should be discarded and a catheterization or
suprapubic tap performed for collection of urine for culture.
NO role for "bag specimens" in my PEM practice!!
> 3. Any child under 2 years old with a fever of undetermined etiology
> have a urine culture sent regardless of the UA or dip urine result.
IF ILL, the above is true.
IF NOT ILL, I would be more selective in my approach. Selectivity based on
age, gender, height of temperature, duration of fever, PaMH, FH (sib has VUR
or viral illness say), SH(day care...etc) etc.
> 4. Any child under 2 years old with fever of undetermined etiology should
> have a urine culture sent if one is going to treat them with antibiotics.
Probably true...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 of
> 102 degrees Fahrenheit may be safely sent home without antibiotics if the
> appropriate work-up is normal and the social/follow-up situation allows.
> 6. In number 5, which of the following constitute an appropriate work-up?
> 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
> [G. NO laboratory Workup]......IF fever only of few hours, with good
FU] I don't believe we have evidence that a delay of 24-48 hours, in the
diagnosis of upper tract disease, in a well looking infant, is associated
with higher morbidity.
Jay Pershad, MD
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