Fever as a sign of urinary tract infection

Abstract

Prevalence of urinary tract infection (UTI) in febrile infants presenting to an emergency department is approximately 3% to 5%, higher than the post-Haemophilus influenza type b era prevalence of occult bacteremia. The majority of young children with febrile UTI arc at risk for kidney damage, especially if diagnosis or treatment is delayed. Fever, however, may be the only sign of UTI in febrile infants, Risk factors include a history of urinary tract anomalies or previous UTI, uncircumcised boys, white patients, age younger than 12 months, the absence of an alter native source for the fever, and height of fever greater than or equal to 39°C. Urine should be obtained for culture because none of the screening tests can rule out UTI definitively. The decision to treat empiric ally should be based tan strong evidence of both pyuria and bacteriuria, Hospital admission is advisable in the child who is dehydrated or toxic-appearing and considered strongly in infants younger than 6 to 12 months of age.