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Urinary Tract Infection in Young Febrile Infants



 
 
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Old September 4th 05, 06:00 AM
Briar Rabbit
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Default Urinary Tract Infection in Young Febrile Infants

PEDIATRICS Vol. 116 No. 3 September 2005, pp. 644-648
(doi:10.1542/peds.2004-1825)

Clinical and Demographic Factors Associated With Urinary Tract Infection
in Young Febrile Infants

Objective. Previous research has identified clinical predictors for
urinary tract infection (UTI) to guide urine screening in febrile
children 24 months of age. These studies have been limited to single
centers, and few have focused on young infants who may be most at risk
for complications if a UTI is missed. The objective of this study was to
identify clinical and demographic factors associated with UTI in febrile
infants who are 60 days of age using a prospective multicenter cohort.

Methods. We conducted a multicenter, prospective, cross-sectional study
during consecutive bronchiolitis seasons. All febrile (38°C) infants who
were 60 days of age and seen at any of 8 pediatric emergency departments
from October through March 1999–2001 were eligible. Clinical appearance
was evaluated using the Yale Observation Scale. UTI was defined as
growth of a known bacterial pathogen from a catheterized specimen at a
level of (1) 50000 cfu/mL or (2) 10000 cfu/mL in association with a
positive dipstick test or urinalysis. We used bivariate tests and
multiple logistic regression to identify demographic and clinical
factors that were associated with the likelihood of UTI.

Results. A total of 1025 (67%) of 1513 eligible patients were enrolled;
9.0% of enrolled infants received a diagnosis of UTI. Uncircumcised male
infants had a higher rate of UTI (21.3%) compared with female (5.0%) and
circumcised male (2.3%) infants. Infants with maximum recorded
temperature of 39°C had a higher rate of UTI (16.3%) than other infants
(7.2%). After multivariable adjustment, UTI was associated with being
uncircumcised (odds ratio: 10.4; bias-corrected 95% confidence interval:
4.7–31.4) and maximum temperature (odds ratio: 2.4 per °C; 95%
confidence interval: 1.5–3.6). Factors that were reported previously to
be associated with risk for UTI in infants and toddlers, such as white
race and ill appearance, were not significantly associated with risk for
UTI in this cohort of young infants.

Conclusions. Being uncircumcised and height of fever were associated
with UTI in febrile infants who were 60 days of age. Uncircumcised male
infants were at particularly high risk and may warrant a different
approach to screening and management.

http://pediatrics.aappublications.or...edi atricsâ™*
 




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