Non Aggressive Management of Urinary Tract Infection in Previously Healthy Febrile Infants

Abstract

Background: The correct management of febrile urinary tract infections (UTI) is important to prevent acute complications and long-term kidney damage. Diagnosis of UTI is difficult in infants, what often leads to aggressive procedures to collect urine samples and urgent therapy. Methods: Infants who attended a university hospital pediatric emergency room and met the following inclusion criteria were studied: 3-12 months of age, good general condition, fever of recent onset (<24 hours), unidentified source of fever by the physical examination, leukocyturia and normal or mildly elevated concentrations of serum acute phase reactants. The outcome and clinical course of 22 patients with UTI in whom urine samples were collected by perineal bags and treatment was deferred at least 12 hours (prospective group) were compared with those of 21 infants with UTI in whom urine had been collected by urethral catheterization or suprapubic aspiration and immediate hospitalization and intravenous antibiotics had been prescribed (retrospective group). Results: Presenting manifestations were similar in both groups. The fever's duration did not differ but the time of stay at the hospital and the estimated cost of the process were significantly greater in the group of infants initially hospitalized. In this group, concurrent illnesseswere 4 times more common. The percentage of patients who developed kidney scars was similar in both groups. A positive leukocyte esterase test in the second urine specimen was the best diagnostic marker of UTI in the prospective group. Conclusions: Non-aggressive management of previously healthy infants who present with fever, leucocyturia, and no sick appearance is safe.