Management of Pediatric Urinary Tract Infections in the Emergency Department (Pharmacology CME)

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Delivery Method:	Online
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Publication Date: January 2024 (Volume 21, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 01/01/2027.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Urinary tract infection (UTI) is a common diagnosis in pediatric patients presenting to the emergency department. Although there are several evidence-based guidelines for UTI, they have small variations that can make the workup and management for UTI challenging. This issue reviews the current state of the literature and best practices for the diagnosis and management of UTI in children presenting to the emergency department, including criteria to help the clinician decide whether to test a patient’s urine, the best method for urine testing based on the clinical scenario, and how to manage the patient based on the results of urine testing. Also discussed is the best antibiotic choice for specific patients, including the route of administration and duration.

Case Presentations

A 40-day-old girl presents with fever...

• The girl has no past medical history and a normal birth history. Her parents say that she felt warm to the touch earlier today, so they took a rectal temperature, which was 100.8°F (38.2°C). They called their pediatrician’s office and were told to take the child to the ED. The parents tell you the girl has otherwise been asymptomatic, has continued to take her regular feeds, and has normal urine output.
• On physical examination, the girl is well-appearing, with no focal signs of infection. You initiate a standard workup for a febrile infant. Her CBC, CRP, and procalcitonin are within normal limits, and a blood culture is sent. You obtain urine for a urinalysis via sterile catheterization of the urethra. The urinalysis shows 3+ leukocyte esterase and many bacteria, with no nitrites. You send the urine for culture as well. The girl continues to be well-appearing.
• How do you interpret her urinalysis? What further management should you provide?

A 9-month-old boy with no past medical history presents with a fever for 3 days…

• The parents tell you he had a maximum temperature of 100.6°F (38.1°C). Prior to the onset of his fever, he had a few days of cough and rhinorrhea, which have now resolved.
• You note a well-appearing child who is uncircumcised and has a normal physical examination.
• Should you work up this child for a possible urinary tract infection? If so, how should you obtain a urine specimen? What are the diagnostic criteria for treatment? How would you treat him if you determine that he has a urinary tract infection?

A 16-year-old sexually active girl presents with dysuria and increased urinary frequency for the past week…

• The girl has no significant past medical history. She has been afebrile and denies abdominal pain or any changes to her vaginal discharge. She reports that she has had 2 lifetime sexual partners. She states that she has never been tested for a sexually transmitted infection, as she does not think it has been necessary, since she is in a monogamous relationship.
• What is your differential diagnosis for this patient? What should your evaluation of this patient include?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.