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I am interested in the group's response to the following statements regarding
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 should
be collected by catheter or suprapubic tap.
 
 
- If you would change the age let me know this as well.
 
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.
 
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.
 
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.
 
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
 
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  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html