by Katie Donnelly (EM) and Jamie Librizzi (HM), Children’s National

UTI take home points:
Definitions:
– UTI= detection of significant bacteria in the urine with associated signs/symptoms
– Cystitis= inflammation of the bladder (may or may not include upper urinary tract infection
– Pyelonephritis= diffuse pyogenic infection of pelvis and parenchyma of kidney
– UTI with systemic signs including fever often presumed to be pyelonephritis – studies have shown small percentage of these cases actually have radiographic evidence of upper urinary tract infection

Neonate Febrile UTI
– UTI most common SBI in febrile infants (prevalence ~5-10%)
– 20 center retrospective review of infants 29-60d with fever >38 and culture proven UTI over 11 years – bacteremia in 123/1877 infants (6.5%, CI 5.5-7.7%), meningitis 2/1609 (0.1%, CI 0-0.4%); presence of clinical illness in ED was variable most strongly associated with adverse events (including meningitis) and peripheral band count greater than 1250 and ANC less than 1500 most strongly associated with bacteremia
– Single center Australian retrospective review of patients 0-16y with UTI over 9 years- ONLY 2 cases of meningitis both in 0-30d age group who were ill appearing on presentation (1/2%, CI 0.15-4%)
– Sterile pleocytosis associated with UTI (prevalence ~18%)

Toddler UTI
– AAP guidelines: perform only cath or suprapubic aspiration (40% misdiagnosis with bag specimens)
– BMJ Systematic Review- neg dipstick for LE/nitrite or microscopic neg for WBC or bacteriuria sufficient to rule out UTI
– Hospital LOS decreases with age, use of clinical guideline, increased with % Medicaid population (PHIS study)

Adolescent UTI/STI
– PID= lower abd tenderness, bilateral adnexal tenderness, cervical motion tenderness; Cervicitis= abnl vaginal bleeding, unusual vaginal discharge, painful sexual activity
– UTI and STI co-infection rate btw 17-51%
– Low inter-rater reliability for bimanual exams; considering removing the exam for routine screening of healthy patients
– When interpreting urine studies, LE/blood more likely STI and nitrite/protein more likely UTI but still difficult to distinguish therefore recommend empirically testing and/or treating high risk patients