PREVALENCE OF URINARY-TRACT INFECTION IN FEBRILE INFANTS

Urinary tract infection (UTI), a relatively common cause of fever in i nfancy, usually consists of pyelonephritis and may cause permanent ren al damage. This study assessed (1) the prevalence of UTI in febrile in fants (temperature greater-than-or-equal-to 38.3-degrees-C) with diffe ring demographic and clinical characteristics and (2) the usefulness o f urinalysis in diagnosing UTI. We diagnosed UTI in 50 (5.3%) of 945 f ebrile infants it we found greater-than-or-equal-to 10,000 colony-form ing units of a single pathogen per milliliter in a urine specimen obta ined by catheterization. Prevalences were similar in (1) infants aged less-than-or-equal-to 2 months undergoing examination for sepsis (4.6% ), (2) infants aged >2 months in whom UTI was suspected, usually becau se no source of fever was apparent (5.9%), and (3) infants with no sus pected UTI, most of whom had other illnesses (5.1%). Female and white infants had significantly more UTIs, respectively, than male and black infants. In all, 17% of white female infants with temperature greater -than-or-equal-to 39-degrees-C had UTI, significantly more (p <0.05) t han any other grouping of infants by sex, race, and temperature. Febri le infants with no apparent source of fever were twice as likely to ha ve UTI (7.5%) as those with a possible source of fever such as otitis media (3.5%) (p = 0.02). Only 1 (1.6%) of 62 subjects with an unequivo cal source of fever, such as meningitis, had UTI. As indicators of UTI , pyuria and bacteriuria had sensitivities of 54% and 86% and specific ities of 96% and 63%, respectively. In infants with fever, clinicians should consider UTI a potential source and consider a urine culture as part of the diagnostic evaluation.