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Here's my 2cents:
 
1.  All urine specimens for culture in children under 2 years of age
should
be collected by catheter or suprapubic tap.
 
 
- If you would change the age let me know this as well.
 
Like Jay, I use toilet trained or not.
 
2.  In children being worked up for a possible occult urinary tract
infection, bag specimens are only possibly helpful if the UA is
negative and
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.
 
 
I agree with this statement.
 
3.  Any child under 2 years old with a fever of undetermined etiology
should
have a urine culture sent regardless of the UA or dip urine result.
 
I dont agree. I think that Hoberman et al (in a reference I dont have
handy) demonstrated to my satisfaction that positive cultures without
pyuria are asymptomatic bacturia found when the kid has a fever of
another source.  Plus circumsized boys have such a low risk of UTI
that I practically never look for it.
 
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.
 
Depends. If you are treating "occult bacteremia", and the child is
anything but a circumsized male then I agree.  But if you have a real
otitis or lobar consolidation then I wouldnt look for a UTI.
 
 
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.
 
 
Absolutely!!
 
 
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
 
None of the above unless specifically indicated.
 
 
 
David
__________________________________________
David F. Soglin, M.D.
Chairman, Pediatric Emergency Medicine
Cook County Children's Hospital
Chicago, IL
 
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