Prevalence of Urinary Tract Infection in Febrile Infants With Upper Respiratory Tract Symptomatology

Bolivar, Patricia; Ponga, Pilar de; Granda, Elena; Velasco, Roberto

doi:10.1097/inf.0000000000002829

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…11 However, a prospective cohort study from Spain including 439 infants with upper respiratory tract symptoms reported that 19 (4.3%) were diagnosed with febrile UTI. 8 Several studies from the United States showed that the incidence of UTI in febrile infants with bronchiolitis ranged from 4.5% to 7.7% and was highest in female or uncircumcised male patients. [12][13][14] Considering the results in our study, where all patients were female or uncircumcised male infants, clinicians should consider UTI in febrile infants with risk factors for UTI, even if they have respiratory symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…7 Infants 2–24 months of age who were diagnosed with “urinary tract infection” in the DPC data from March 1, 2012, to May 31, 2023, and who were admitted to the general pediatrics department were found using a search engine of DPC data. We further selected cases that met all the following diagnostic criteria of febrile UTI 8,9 : (1) pyuria on urinalysis obtained in the ED (defined as more than 5 white blood cells per high-power field); (2) isolation of at least 10 4 colony forming units per milliliter of single uropathogens from a urine culture obtained by catheterization; (3) body temperature greater than or equal to 38 °C measured in the ED or by caregivers within the 24 hours before the presentation.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Treatment Delay of Febrile Urinary Tract Infections Among Infants With Respiratory Symptoms

Iio,

Mikami,

Harada

et al. 2023

Pediatric Infectious Disease Journal

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Objective: To evaluate whether antibiotic treatment of febrile urinary tract infection (UTI) is delayed in febrile infants with respiratory symptoms compared with those without. Study Design: Data of infants 2–24 months of age diagnosed with UTI from March 1, 2012 to May 31, 2023 were collected from our hospital’s medical charts and triage records. Patients with known congenital anomalies of the kidney and urinary tract or a history of febrile UTI were excluded. Patients were classified as having respiratory symptoms if they had any of the following symptoms or clinical signs: cough, rhinorrhea, pharyngeal hyperemia and otitis media. Time to first antibiotic treatment from fever onset was compared between patients with and without respiratory symptoms. A Cox regression model was constructed to adjust for potential confounders. Results: A total of 214 patients were eligible for analysis. The median age of the eligible patients was 5.0 months (interquartile range: 3.0–8.8) and 118 (55%) were male. There were 104 and 110 patients in the respiratory symptom and no respiratory symptom groups, respectively. The time to first antibiotic treatment was significantly longer in the group with respiratory symptoms (51 hours vs. 21 hours). Respiratory symptoms were significantly associated with a longer time to first treatment after adjustment for age and sex in the Cox regression model (hazard ratio = 0.63, 95% confidence interval: 0.47–0.84). Conclusions: Treatment of febrile UTI infants with respiratory symptoms tends to be delayed. Pediatricians should not exclude febrile UTI even in the presence of respiratory symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Treatment Delay of Febrile Urinary Tract Infections Among Infants With Respiratory Symptoms

Iio,

Mikami,

Harada

et al. 2023

Pediatric Infectious Disease Journal

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“…14 Nonetheless, a prospective cohort study from Spain of 439 infants (male, <12 months; female, <24 months) with upper respiratory tract symptoms found 19 (4.3%) were diagnosed with UTI. 15 In a single-centre study from the United States of 90 febrile infants (2 to 12 months of age) with clinically diagnosed bronchiolitis, 4 (4.4%) were diagnosed with UTI. 16 This study was subsequently expanded to a prospective, multicentre cohort study of 442 patients with clinically diagnosed bronchiolitis and found that 33 (7.5%) had a concomitant UTI.…”

Section: Infants 2 To 24 Months Of Agementioning

confidence: 99%

Should you test for urinary tract infection in children with respiratory symptoms?

Iio,

Goldman

2024

Can Fam Physician

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Question An 8-month-old boy presented to our clinic with a 3-day history of fever. He has had a cough and rhinorrhea since the onset of the fever, and his 4-year-old sibling has recently had cough and cold symptoms. I have heard that the presence of respiratory symptoms means that urinary tract infection (UTI) is less likely. In infants with fever and respiratory symptoms, who should have a sample collected for urinalysis for UTI?Answer The approach to diagnosing febrile infants who have respiratory symptoms varies by age. Urinalysis should be done for all febrile infants younger than 2 months of age, regardless of whether they have respiratory symptoms. Clinicians should assess risk factors for UTI in every infant between 2 and 24 months of age and should not exclude the diagnosis of UTI based on respiratory symptoms alone. Use of a predictive tool to estimate the pretest probability of UTI would aid decision making about patients in this population.

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“…Previous data of febrile infants showed a non-negligible prevalence also in older patients, even though they had viral symptoms. 55 On the other hand, a meta-analysis of UTI and bronchiolitis revealed a lower prevalence of UTI when a strict criterion for diagnosis was established. 56 In our study, the prevalence of UTI was below 1%, although the variation in UTI prevalence between studies was much greater than that found between IBIs.…”

Section: Systematic Reviewmentioning

confidence: 99%

Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis

Pérez-Porra,

Granda,

Benito

et al. 2023

Emerg Med J

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BackgroundFebrile infants with an infection by influenza or enterovirus are at low risk of invasive bacterial infection (IBI).ObjectiveTo determine the prevalence of IBI among febrile infants ≤90 days old with a positive COVID-19 test.MethodsMEDLINE, Embase, Cochrane Central Register databases, Web of Science, ClinicalTrials.gov and grey literature were searched for articles published from February 2020 to May 2023. Inclusion criteria: researches reporting on infants ≤90 days of age with fever and a positive test for SARS-CoV-2 (antigen test/PCR). Case reports with <3 patients, articles written in a language other than English, French or Spanish, editorials and other narrative studies were excluded. Preferred Reposting Items for Systematic Reviews and Meta-analysis guidelines were followed, and the National Institutes of Health Quality Assessment Tool was used to assess study quality. The main outcome was the prevalence of IBI (a pathogen bacterium identified in blood and/or cerebrospinal fluid (CSF)). Forest plots of prevalence estimates were constructed for each study. Heterogeneity was assessed and data were pooled by meta-analysis using a random effects model. A fixed continuity correction of 0.01 was added when a study had zero events.ResultsFrom the 1023 studies and 3 databases provided by the literature search, 33 were included in the meta-analysis, reporting 3943 febrile infants with a COVID-19 positive test and blood or CSF culture obtained. The pooled prevalence of IBI was 0.14% (95% CI, 0.02% to 0.27%). By age, the prevalence of IBI was 0.56% (95% CI, 0.0% to 1.27%) in those 0–21 days old, 0.53% (95% CI, 0.0% to 1.22%) in those 22–28 days old and 0.11% (95% CI, 0.0% to 0.24%) in those 29–60 days old.ConclusionCOVID-19-positive febrile infants ≤90 days old are at low risk of IBI, especially infants >28 days old, suggesting this subgroup of patients can be managed without blood tests.PROSPERO registration numberCRD42022356507.

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Prevalence of Urinary Tract Infection in Febrile Infants With Upper Respiratory Tract Symptomatology

Cited by 5 publications

References 10 publications

Treatment Delay of Febrile Urinary Tract Infections Among Infants With Respiratory Symptoms

Treatment Delay of Febrile Urinary Tract Infections Among Infants With Respiratory Symptoms

Should you test for urinary tract infection in children with respiratory symptoms?

Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis

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