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Fever poor predictor of bacteremia in infants with UTI
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Fever and a urinary tract infection were not good predictors of bacteremia in infants, according to recent study findings published in The Pediatric Infectious Disease Journal.
Susanna Hernández-Bou, MD and colleagues from the pediatric emergency department at Hospital Sant Joan de Déu Barcelona in Spain, evaluated 350 infants aged 29 to 90 days with UTI from September 2006 through May 2009. Clinical and laboratory factors associated with bacteremia were identified with univariate testing.
Twenty-two percent of the patients were afebrile. The afebrile patients had urine studies obtained because of irritability, feeding difficulties or vomiting: most had a combination of symptoms.
Escherichia coli was the most common pathogen isolated from urine cultures (87.1%). Bacteremia was present in 10 patients (2.9%; 95% CI, 1.6-5.2). No cases of bacterial meningitis were reported from any of the 19 lumbar punctures.
Procalcitonin (PCT) was higher in patients with bacteremia (9.2 ng/mL) compared with patients without bacteremia (0.3 ng/mL); however, no other differences were found.
“We concluded that fever was not a predicting factor for bacteremia in very young children with a UTI, so the management of these patients need not be different if fever is present or absent,” the researchers wrote. “Furthermore, well appearing infants aged 29 to 90 days with a UTI and a PCT value less than 0.7 ng/mL were at very low risk of bacteremia. Outpatient management with oral or long-acting intramuscular antibiotics and close follow-up should be considered for this group of infants.”
Disclosure: The researchers report no relevant financial disclosures.
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