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On Nov 3, 2014, at 4:34 AM, Nathan Kuppermann <[log in to unmask]> wrote:

> Greetings
> 
> A little clarification
> 
> Several studies have documented a non-inconsequential rate of UTI in febrile young infants with bronchiolitis as the Venn diagram between these two common illnesses in young febrile infants exists
> 
> With regards to the specific articles you site: 
> 
>> • Kuppermann N et al. Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis.
>> Arch Pediatr Adolesc Med. 1997 Dec;151(12):1207-14. PMID: 9412595. He found a 2% prevalence of urinary tract infection with concomitant RSV.
> 
> This was a study of febrile infants up to 24 months old.  Of the 2% of infants  with bronchiolitis and UTIs, one had grade 3 VUR in association with a growth of > 100K cfu of E.Coli. The second patient had 10-20 WBC per hpf in the UA associated with >100K growth of Klebsiella. 
> 
> 
> The second article you reference was of febrile infants < 60 days. The rate of UTI in the RSV+ group was 5.4%, not 2%. 
> 
>> • Levine DA et al. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004 Jun;113(6):1728-34.
>> PMID: 15173498. Found a similar rate.

> Others have found similar associations in this age group.
> 
> 
> Best, Nate
> 
> 
> __________________________
> Nathan Kuppermann, MD, MPH
> Professor, Departments of Emergency Medicine and Pediatrics
> Bo Tomas Brofeldt Endowed Chair, Department of Emergency Medicine
> University of California, Davis School of Medicine
> 
> Principal Investigator, PRIME Node, Pediatric Emergency Care Applied Research Network (PECARN)
> Chair, Steering Committee, (global) Pediatric Emergency Research Networks (PERN)
> 
> 916-734-1535 phone
> 916-734-7950 fax
> 916-762-8620 page
> [log in to unmask]
> 
> On Nov 2, 2014, at 9:54 PM, Fred Wu <[log in to unmask]> wrote:
> 
>> All,
>> 
>> I was always under the impression that RSV+ children have a low rate of SBI but still run the risk of UTI.
>> 
>> A colleague of mine is quoting a recent EMRAP episode which discourages checking the UA in bronchiolitis.
>> 
>> "What is the deal with urine testing in patients with bronchiolitis? This came from two studies.
>> 
>> • Kuppermann N et al. Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis.
>> Arch Pediatr Adolesc Med. 1997 Dec;151(12):1207-14. PMID: 9412595. He found a 2% prevalence of urinary tract infection with concomitant RSV.
>> 
>> • Levine DA et al. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004 Jun;113(6):1728-34.
>> PMID: 15173498. Found a similar rate.
>> 
>> • However, this is similar to the baseline rate of culture-positive urine in asymptomatic children under the age of 3 years, randomly selected for testing. You don’t need to check the urine in febrile children with bronchiolitis."
>> 
>> What are everyone's thoughts?
>> 
>> Thanks,
>> Fred
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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> 


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