Prevalence of urinary tract infection in infants with high fever in the emergency department

Abstract

IntroductionThere is no current data on the prevalence of urinary tract infection (UTI) in infants and toddlers with high fever. We conducted this study to assess the point prevalence of UTI in children aged less than 2 years presenting with high fever to the emergency department. MethodsWe conducted a prospective, multicentre, observational study including febrile children aged less than 2 years in whom urinalysis was performed to rule out UTI over a 1-year period in seven paediatric emergency departments in Spain. Boys younger than 1 year and girls younger than 2 years of age were eligible for the study if they had a rectal temperature greater than 39°C, were not taking antibiotics, and there was no identifiable source of fever. The diagnosis of UTI was based on the presence of leukocyturia and positive urine culture results. ResultsWe included a total of 1675 patients. Two hundred sixty infants (15.5%; 95% CI, 13.8–17.3%) received a diagnosis of UTI. The point prevalence of UTI was 32.9% (95% CI, 26.6–39.9%) in febrile boys aged less than 6 months and 19.3% (95% CI, 16.1–22.9%) in febrile girls aged less than 12 months. The point prevalence of UTI was 13% (95% CI, 10.8–15.6%) in children with a duration of fever of less than 24h, compared to 17.5% (95% CI, 15.2–20.1%) in those with a longer duration of fever (P=.014). ConclusionsThe point prevalence of UTI in infants and toddlers with fever without source greater than 39°C was higher in our study compared to previous studies of UTI prevalence, especially in male infants aged less than 6 months and female infants aged less than 12 months. Our findings suggest that clinicians need to carefully assess for UTI in infants with unexplained fever greater than 39°C.