Urinary Tract Infection In Children: Emergency Department Diagnostics And Interventions,
TOC Will Appear Here

Urinary Tract Infection In Children: Emergency Department Diagnostics And Interventions

Below is a free preview. Log in or subscribe for full access. Or, get a free sample article ED Assessment and Management of Pediatric Acute Mild Traumatic Brain Injury and Concussion:
Please provide a valid email address.
Table of Contents
Table of Contents
  1. Abstract
  2. Case Presentation
  3. Introduction
  4. Critical Appraisal Of The Literature
  5. Etiology And Pathophysiology
  6. Differential Diagnosis
  7. Prehospital Care
  8. Emergency Department Evaluation
    1. Preverbal Infants
      1. History Of Present Illness
      2. Physical Examination
    2. Verbal Patients
      1. History Of Present Illness
      2. Physical Examination
  9. Diagnostic Studies
    1. Urinalysis And Urine Culture
    2. Hematuria Testing
    3. Procalcitonin
    4. Additional Testing Based On Clinical Suspicion
  10. Treatment
    1. Intravenous Versus Oral Therapy
    2. Length Of Treatment Required
  11. Special Populations
  12. Controversy And Cutting Edge
    1. Use Of Procalcitonin Testing
    2. Risk Of Significant Renal Damage
    3. Day Treatment Centers
  13. Disposition
  14. Summary
  15. Clinical Pathway For Management Of Pediatric Urinary Tract Infection
  16. Risk Management Pitfalls For Pediatric Urinary Tract Infections
  17. Time- And Cost-Effective Strategies
  18. Case Conclusions
  19. Tables and Figures
    1. Table 1. Signs And Symptoms For Evaluation Of Pediatric Urinary Infection
    2. Table 2. Risk Stratification Prior To Testing For Urinary Tract Infection In Febrile Infants
    3. Table 3. Sensitivity And Specificity Of Different Urinary Test For Diagnosis Of Urinary Tract Infection
    4. Table 4. Comparison Of Previous And Updated Practice Guidelines From The American Academy Of Pediatrics
  20. References


Pediatric patients represent a significant portion of patients in the emergency department, and they often present with nonspecific complaints (such as fussiness, decreased oral intake, crying, or fever), which can pose a diagnostic dilemma. One serious cause for these complaints that should be considered is a urinary tract infection. Approximately 7% of fevers in pediatric patients presenting to the ED are caused by a bacterial infection of the normally sterile urinary system, and there is a litany of ways in which a young patient can manifest a urinary tract infection. This review will discuss the epidemiology, natural history, and pathophysiology of urinary tract infections in children. Pertinent history and physical examination findings as well as the diagnostic and treatment modalities will be examined, with the goal of providing updated evidence on the varied options in managing a patient once diagnosed. Controversies in the exact diagnosis of a urinary tract infection as well as a review of novel concepts in the management of this condition will also be presented.

Case Presentation

Two anxious parents arrive at the ED with an 8-month-old male who has a chief complaint of tactile fever lasting 2 days. They state that he has been drinking less than normal and that his urine has a distinct odor. His parents deny any cough, coryza, vomiting, diarrhea, or rash. He stools daily, and he last moved his bowels a small amount the previous day. The triage vital signs are: temperature, 39.7°C; heart rate, 160 beats/min; respiration, 25 breaths/min; and oxygen saturation, 98%. Physical examination reveals a well-appearing male with moist mucous membranes, no respiratory distress, a mildly distended abdomen, and an uncircumcised penis. Examination of the head, ears, eyes, nose, and throat is normal. A straight-catheterized urine sample is positive for nitrites. You wonder if there are any other tests that should be ordered, and if the child should be admitted. You further question if there are any predisposing factors to UTI that also need to be addressed.

An 18-year-old female presents to the ED complaining of 3 days of lower abdominal discomfort with mild dysuria. Her mother tells the triage nurse she just wants an antibiotic for her daughter’s bladder infection and indicates that they need to get in and out quickly. The teenager is afebrile and has normal vital signs. She takes no medicines except birth control pills and is otherwise healthy. While the mother is asking about the antibiotics, you wonder if history alone is sufficient to diagnose and treat UTI. Should you talk to the patient outside the presence of her mother? Can you just dip her urine and rapidly discharge her?

A 9-week-old child with fever to 40°C presents to the ED with her parents. She is slightly lethargic initially and has dry mucous membranes, but she improves with IV fluids and acetaminophen. She has a cough with scattered rales and wheezing on lung examination. Chest x-rays show mild hyperinflation with some peribronchial cuffing. She is breathing comfortably, but is still not tolerating liquids orally. Rapid RSV test is positive. At this point, you question whether any further testing is required and if the patient can be sent home with close follow-up.


A urinary tract infection (UTI) results from bacterial colonization of any part of the genitourinary tract, which is a normally sterile system. UTI is one of the most common infections in children, with a cumulative incidence of 3% to 7% in females and 1% to 2% in males.1,2 UTIs result in > 1.1 million physician visits and 500,000 emergency department (ED) visits per year in the United States, accounting for 0.7% of all physician visits and approximately 7% of febrile presentations in the ED.1,3,4 Before the advent of antimicrobials in the 1930s, febrile UTI carried a 20% mortality rate in children.5 This has greatly decreased with antibiotics, but UTI is still considered a significant source of serious bacterial infections, causing bacteremia in 2% to 4% of cases, and carrying the risk of sepsis.6,7 Historically, there has been concern for significant long-term risks of having a UTI (such as renal scarring and the subsequent development of hypertension, chronic kidney disease, and preeclampsia);8,9,10 however, a more recent systemic review highlighted that, while there is a significant risk of renal scarring (affecting 1 in 7 children), there is a great disparity in evidence demonstrating how often subsequent pathology from the scarring occurs.11 The emergency clinician plays an important role in the diagnosis and management of UTI in children. In this issue, we will discuss key points regarding the diagnosis, treatment, and disposition of pediatric UTIs, issues that may arise under special circumstance, and several new developments in the management of UTIs.

Critical Appraisal Of The Literature

A literature search was performed using the PubMed, OVID, and Cochrane databases. Searches were limited to those studies published in English involving human subjects dating back to 1990. Search terms included: pediatric, urinary tract infection, UTI, pyelonephritis, vesicoureteral reflux, fever, circumcision, and urinalysis. Articles deemed relevant were read, and references within were reviewed. The Cochrane Database of Systematic Reviews was searched for any pertinent systematic reviews or meta-analyses. The American Academy of Pediatrics (AAP) practice parameters and previously published guidelines were also utilized. The Infectious Diseases Society of America has no guidelines regarding pediatric urinary tract infections. The total body of literature included systematic reviews, meta-analyses, randomized controlled trials, prospective trials, retrospective analyses, and case reports. A total of 1286 studies were scrutinized, using abstracts, when available, and then were determined applicable based on their relevance to the scope of this article.

Risk Management Pitfalls For Pediatric Urinary Tract Infections

  1. “The patient never made urine, so I just empirically treated for UTI.” It is vital to obtain an appropriate urine specimen, both for diagnosis and for later antibiotic- sensitivity assessment. If the patient has no urine, even on bladder catheterization, then significant dehydration and possibly a more serious infection should be considered.
  2. “I prescribed an antibiotic, so I’m not sure why the patient returned with sepsis.” Not only is it vital to make sure that the patient’s bacterial agent is sensitive to your antibiotic, you must make sure that he or she can actually tolerate oral intake before discharge and has not had difficulty with oral medications in the past.
  3. “The patient’s mom didn’t want her child to have an intravenous line, so I thought oral antibiotics were the right choice.” While it is prudent to minimize trauma and harm to the child, there are certain indications that warrant intravenous antibiotics, including sepsis, inability to tolerate oral intake, evidence of pyelonephritis, and significant dehydration.
  4. “I treated the patient with locally-susceptible antibiotics. I don’t know why her condition did not improve.” While verifying local susceptibilities is important, assessing the patient for risk factors (such as pediatric intensive care unit stay, immunosuppression, renal transplant, recurrent UTIs, or genitourinary deformities) is also necessary in determining the proper pharmacologic agent.
  5. “The adolescent girl complained of dysuria and was certain it was a UTI because her mom had recurrent cystitis. I treated it, even though the urinalysis was unremarkable.” In adolescent females, sexually transmitted diseases must be on the differential for complaints of dysuria, and, in the presence of any uncertainty, a pelvic examination is necessary. Asking the parent to leave the room in order to obtain a more detailed history is always warranted, especially in this age population. It is also not uncommon for urine WBCs or LE to be elevated in a patient with sexually transmitted urethritis or cervicitis. Risk Management Pitfalls For Pediatric Urinary Tract Infections
  6. “The patient was afebrile in the ED, so I didn’t consider UTI.” It is important in pediatric populations to note in the history the patient’s objective or even subjective febrile temperatures before presentation to the ED, especially as the child may have received anti-inflammatory medications prior to arrival. Additionally, it is important to remember that not all UTIs present with fever.
  7. “I didn’t check for a UTI because the patient is a boy.” In male patients aged < 2 years and, especially male patients aged < 6 months, UTI is not uncommon and approaches the prevalence of this condition in females. For male patients aged> 2 years, circumcision status should be sought, as uncircumcised males still have a higher prevalence of UTIs.
  8. “The patient’s father didn’t want us to catheterize his newborn baby, so we placed an adhesive bag. When the UA showed bacteria, I treated it.” In all infants and toddlers who are not toilet-trained, an adhesive bag, regardless of perineal cleansing, is not as specific as a straight catheterization. Contaminated specimens from a bag may result in unnecessary treatment or a missed diagnosis.
  9. “The 3-month-old looked great. I can’t believe his dad is threatening to sue because I didn’t admit him.” New guidelines suggest that infants aged > 2 months who appear well can be sent home on oral antibiotics. Additionally, new studies have shown that patients “on the cusp” can obtain effective treatment in facilities that provide daily ambulatory intravenous antibiotics.
  10. “I treated the otherwise healthy girl who had positive nitrites and LE on dipstick with an antibiotic. How would I have known that it was not a sensitive antibiotic?” While it is acceptable to treat a patient with a strongly positive urine dipstick, sending the urine for a formal culture is recommended to ensure a correct diagnosis and to confirm that the antibiotic choice was appropriate.

Tables and Figures

Table 1. Signs And Symptoms For Evaluation Of Pediatric Urinary Infection


Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study will be included in bold type following the reference, where available.

  1. Conway PH, Cnaan A, Zaoutis T, et al. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA. 2007;298(2):179-186. (Cohort; 74,974 patients)
  2. Marild S, Jodal U. Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr. 1998;87(5):549-552. (Open randomized controlled trial; 547 patients)
  3. Freedman AL. Urologic diseases in North America Project: trends in resource utilization for urinary tract infections in children. J Urol. 2005;173(3):949-954. (Epidemiological study; economic model)
  4. Shaikh N, Morone NE, Bost JE, et al. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008;27(4):302-308. (Meta-analysis)
  5. Hansson S, Martinell J, Stokland E, et al. The natural history of bacteriuria in childhood. Infect Dis Clin North Am. 1997;11(3):499-512. (Review)
  6. Hoberman A, Wald ER, Hickey RW, et al. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics. 1999;104(1 Pt 1):79-86. (Prospective randomized controlled trial; 306 patients)
  7. Honkinen O, Jahnukainen T, Mertsola J, et al. Bacteremic urinary tract infection in children. Pediatr Infect Dis J. 2000;19(7):630-634. (Retrospective study; 134 patients)
  8. Vachvanichsanong P. Urinary tract infection: one lingering effect of childhood kidney diseases--review of the literature. J Nephrol. 2007;20(1):21-28. (Review)
  9. Wennerstrom M, Hansson S, Jodal U, et al. Renal function 16 to 26 years after the first urinary tract infection in childhood. Arch Pediatr Adolesc Med. 2000;154(4):339-345. (Follow-up investigation; 108 patients)
  10. Jacobson SH, Eklof O, Eriksson CG, et al. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ. 1989;299(6701):703-706. (Follow-up investigation, retrospective review; 30 patients)
  11. Shaikh N, Ewing AL, Bhatnagar S, et al. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010;126(6):1084-1091. (Systematic review)
  12. Hoberman A, Chao HP, Keller DM, et al. Prevalence of urinary tract infection in febrile infants. J Pediatr. 1993;123(1):17- 23. (Prospective case study; 945 patients)
  13. Zorc JJ, Levine DA, Platt SL, et al. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics. 2005;116(3):644-648. (Prospective study; 1025 patients)
  14. Spencer JD, Schwaderer A, McHugh K, et al. Pediatric urinary tract infections: an analysis of hospitalizations, charges, and costs in the USA. Pediatr Nephrol. 2010;25(12):2469-2475. (Retrospective analysis; epidemiological study)
  15. Hoberman A, Wald ER. Urinary tract infections in young febrile children. Pediatr Infect Dis J. 1997;16(1):11-17. (Prospective study; 947 patients)
  16. Avlan D, Gundogdu G, Taskinlar H, et al. Relationships among vesicoureteric reflux, urinary tract infection and renal injury in children with non-neurogenic lower urinary tract dysfunction. J Pediatr Urol. 2011;7(6):612-615. (Retrospective review; 96 patients)
  17. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. 1997;100(2 Pt 1):228-232. (Prospective study; 234 patients)
  18. Feber J, Spatenka J, Seeman T, et al. Urinary tract infections in pediatric renal transplant recipients--a two center risk factors study. Pediatr Transplant. 2009;13(7):881-886. (Retrospective cross-sectional study; 76 patients)
  19. Bagga A, Tripathi P, Jatana V, et al. Bacteriuria and urinary tract infections in malnourished children. Pediatr Nephrol. 2003;18(4):366-370. (Prospective case control study; 112 patients)
  20. Chen L, Baker MD. Racial and ethnic differences in the rates of urinary tract infections in febrile infants in the emergency department. Pediatr Emerg Care. 2006;22(7):485-487. (Retrospective review; 465 patients)
  21. Shaikh N, Morone NE, Lopez J, et al. Does this child have a urinary tract infection? JAMA. 2007;298(24):2895-2904. (Systematic review)
  22. Stojanovic VD, Milosevic BO, Djapic MB, et al. Idiopathic hypercalciuria associated with urinary tract infection in children. Pediatr Nephrol. 2007;22(9):1291-1295. (Prospective case control study; 105 patients)
  23. Emamghorashi F, Mahmoodi N, Tagarod Z, et al. Maternal urinary tract infection as a risk factor for neonatal urinary tract infection. Iran J Kidney Dis. 2012;6(3):178-180. (Prospective study; 114 patients)
  24. Fahimzad A, Taherian M, Dalirani R, et al. Diaper type as a risk factor in urinary tract infection of children. Iran J Pediatr. 2010;20(1):97-100. (Prospective case control study; 59 patients)
  25. Katikaneni R, Ponnapakkam T, Ponnapakkam A, et al. Breastfeeding does not protect against urinary tract infection in the first 3 months of life, but vitamin D supplementation increases the risk by 76%. Clin Pediatr (Phila). 2009;48(7):750- 755. (Retrospective study; 315 patients)
  26. Ma JF, Shortliffe LM. Urinary tract infection in children: etiology and epidemiology. Urol Clin North Am. 2004;31(3):517- 526, ix-x. (Review)
  27. Prelog M, Schiefecker D, Fille M, et al. Febrile urinary tract infection in children: ampicillin and trimethoprim insufficient as empirical mono-therapy. Pediatr Nephrol. 2008;23(4):597 -602. (Retrospective study; 694 patients)
  28. Yoon JE, Kim WK, Lee JS, et al. Antibiotic susceptibility and imaging findings of the causative microorganisms responsible for acute urinary tract infection in children: a five-year single center study. Korean J Pediatr. 2011;54(2):79-85. (Retrospective study; 900 patients)
  29. Ismaili K, Wissing KM, Lolin K, et al. Characteristics of first urinary tract infection with fever in children: a prospective clinical and imaging study. Pediatr Infect Dis J. 2011;30 (5):371- 374. (Prospective study; 209 patients)
  30. Becerra MR, Tantalean JA, Suarez VJ, et al. Epidemiologic surveillance of nosocomial infections in a pediatric intensive care unit of a developing country. BMC Pediatr. 2010;10:66. (Prospective study; 418 patients)
  31. Brindha SM, Jayashree M, Singhi S, et al. Study of nosocomial urinary tract infections in a pediatric intensive care unit. J Trop Pediatr. 2011;57(5):357-362. (Prospective study; 287 patients)
  32. Watt K, Waddle E, Jhaveri R. Changing epidemiology of serious bacterial infections in febrile infants without localizing signs. PLoS One. 2010;5(8):e12448. (Retrospective review; 668 patients)
  33. Krief WI, Levine DA, Platt SL, et al. Influenza virus infection and the risk of serious bacterial infections in young febrile infants. Pediatrics. 2009;124(1):30-39. (Prospective crosssectional study; 1091 patients)
  34. Levine DA, Platt SL, Dayan PS, et al. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004;113(6):1728-1734. (Prospective, cross-sectional study; 1248 patients)
  35. Kuppermann N, Bank DE, Walton EA, et al. Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis. Arch Pediatr Adolesc Med. 1997;151(12):1207-1214. (Prospective cohort study; 432 patients)
  36. Jeena PM, Coovadia HM, Adhikari M. Probable association between urinary tract infections (UTI) and common diseases of infancy and childhood: a hospital-based study of UTI in Durban, South Africa. J Trop Pediatr. 1996;42(2):112-114. (Retrospective study; 54 patients)
  37. Prentiss KA, Newby PK, Vinci RJ. Adolescent female with urinary symptoms: a diagnostic challenge for the pediatrician. Pediatr Emerg Care. 2011;27(9):789-794. (Prospective cross- sectional study; 211 patients)
  38. Huppert JS, Biro FM, Mehrabi J, et al. Urinary tract infection and Chlamydia infection in adolescent females. J Pediatr Adolesc Gynecol. 2003;16(3):133-137. (Retrospective study; 82 patients)
  39. Nguyen H, Weir M. Urinary tract infection as a possible marker for teenage sex. South Med J. 2002;95(8):867-869. (Retrospective review; 96 patients)
  40. Kanellopoulos TA, Salakos C, Spiliopoulou I, et al. First urinary tract infection in neonates, infants and young children: a comparative study. Pediatr Nephrol. 2006;21(8):1131-1137. (Retrospective study; 296 patients)
  41. Qureshi AM. Clinical presentation of urinary tract infection among children at Ayub Teaching Hospital, Abbottabad. J Ayub Med Coll Abbottabad. 2005;17(2):79-81. (Retrospective review; 100 patients)
  42. Roberts KB, Akintemi OB. The epidemiology and clinical presentation of urinary tract infections in children younger than 2 years of age. Pediatr Ann. 1999;28(10):644-649. (Review)
  43. Shaw KN, Gorelick M, McGowan KL, et al. Prevalence of urinary tract infection in febrile young children in the emergency department. Pediatrics. 1998;102(2):e16. (Crosssectional, prevalence survey; 2411 patients)
  44. Yarden-Bilavsky H, Bilavsky E, Amir J, et al. Serious bacterial infections in neonates with fever by history only versus documented fever. Scand J Infect Dis. 2010;42(11-12):812-816. (Prospective study; 399 patients)
  45. Freedman SB, Al-Harthy N, Thull-Freedman J. The crying infant: diagnostic testing and frequency of serious underlying disease. Pediatrics. 2009;123(3):841-848. (Retrospective; 237 infants)
  46. Pashapour N, Nikibahksh AA, Golmohammadlou S. Urinary tract infection in term neonates with prolonged jaundice. Urol J. 2007;4(2):91-94. (Prospective study; 100 patients)
  47. Chen HT, Jeng MJ, Soong WJ, et al. Hyperbilirubinemia with urinary tract infection in infants younger than eight weeks old. J Chin Med Assoc. 2011;74(4):159-163. (Retrospective study; 217 patients)
  48. Shahian M, Rashtian P, Kalani M. Unexplained neonatal jaundice as an early diagnostic sign of urinary tract infection. Int J Infect Dis. 2012;16(7):e487-490. (Prospective case control study; 242 patients)
  49. Fang SB, Lee HC, Yeung CY, et al. Urinary tract infections in young infants with prolonged jaundice. Acta Paediatr Taiwan. 2005;46(6):356-360. (Retrospective case control study; 50 patients)
  50. Gauthier M, Gouin S, Phan V, et al. Association of malodorous urine with urinary tract infection in children aged 1 to 36 months. Pediatrics. 2012;129(5):885-890. (Prospective cohort study; 331 patients)
  51. Shim YH, Lee JW, Lee SJ. The risk factors of recurrent urinary tract infection in infants with normal urinary systems. Pediatr Nephrol. 2009;24(2):309-312. (Prospective cohort study; 190 patients)
  52. Goldman M, Barr J, Bistritzer T, et al. Urinary tract infection following ritual Jewish circumcision. Isr J Med Sci. 1996;32(11):1098-1102. (Retrospective study; 82 patients)
  53. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610. (Clinical practice guideline)
  54. Cheng YW, Wong SN. Diagnosing symptomatic urinary tract infections in infants by catheter urine culture. J Paediatr Child Health. 2005;41(8):437-440. (Retrospective review; 952 patients)
  55. McGillivray D, Mok E, Mulrooney E, et al. A head-to-head comparison: “clean-void” bag versus catheter urinalysis in the diagnosis of urinary tract infection in young children. J Pediatr. 2005;147(4):451-456. (Prospective cross-sectional study; 303 patients)
  56. Dayan PS, Chamberlain JM, Boenning D, et al. A comparison of the initial to the later stream urine in children catheterized to evaluate for a urinary tract infection. Pediatr Emerg Care. 2000;16(2):88-90. (Prospective study; 86 patients)
  57. Vaillancourt S, McGillivray D, Zhang X, et al. To clean or not to clean: effect on contamination rates in midstream urine collections in toilet-trained children. Pediatrics. 2007;119 (6):e1288-1293. (Randomized prospective controlled trial; 350 patients)
  58. Whiting P, Westwood M, Bojke L, et al. Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model. Health Technol Assess. 2006;10(36):iii-iv, xi-xiii, 1-154. (Systematic review; economic model)
  59. Shaw KN, McGowan KL, Gorelick MH, et al. Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatrics. 1998;101(6):E1. (Prospective cross-sectional study; 3873 patients)
  60. Whiting P, Westwood M, Watt I, et al. Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr. 2005;5(1):4. (Systematic review)
  61. Luco M, Lizama M, Reichhard C, et al. Urine microscopy as screen for urinary tract infections in a pediatric emergency unit in Chile. Pediatr Emerg Care. 2006;22(10):705-709. (Retrospective review; 18,302 patients)
  62. Kwak BO, Chung S, Kim KS. Microalbuminuria in children with urinary tract infection. Korean J Pediatr. 2010;53(9):840- 844. (Cross-sectional control study; 118 patients)
  63. Chen SM, Chang HM, Hung TW, et al. Diagnostic performance of procalcitonin for hospitalised children with acute pyelonephritis presenting to the pediatric emergency department. Emerg Med J. 2013;30(5):406-410. (Prospective study; 136 patients)
  64. Kotoula A, Gardikis S, Tsalkidis A, et al. Procalcitonin for the early prediction of renal parenchymal involvement in children with UTI: preliminary results. Int Urol Nephrol. 2009;41 (2):393-399. (Prospective study; 57 patients)
  65. Park SJ, Oh YS, Choi MJ, et al. Hyponatremia may reflect severe inflammation in children with febrile urinary tract infection. Pediatr Nephrol. 2012;27(12):2261-2267. (Retrospective study; 140 patients)
  66. Huang DT, Huang FY, Tsai TC, et al. Clinical differentiation of acute pyelonephritis from lower urinary tract infection in children. J Microbiol Immunol Infect. 2007;40(6):513-517. (Retrospective study; 590 patients)
  67. Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341(8844):515-518. (Prospective cohort study; 79 patients)
  68. Mantadakis E, Plessa E, Vouloumanou EK, et al. Serum procalcitonin for prediction of renal parenchymal involvement in children with urinary tract infections: a meta-analysis of prospective clinical studies. J Pediatr. 2009;155(6):875-881. e871. (Meta-analysis)
  69. Gervaix A, Galetto-Lacour A, Gueron T, et al. Usefulness of procalcitonin and C-reactive protein rapid tests for the management of children with urinary tract infection. Pediatr Infect Dis J. 2001;20(5):507-511. (Prospective study; 54 patients)
  70. Lee HH, Chernesky MA, Schachter J, et al. Diagnosis of Chlamydia trachomatis genitourinary infection in women by ligase chain reaction assay of urine. Lancet. 1995;345(8944):213-216. (Proof of concept article; 1937 patients)
  71. Newman DH, Shreves AE, Runde DP. Pediatric urinary tract infection: does the evidence support aggressively pursuing the diagnosis? Ann Emerg Med. 2013;61(5):559-565. (Review)
  72. Brady PW, Conway PH, Goudie A. Length of intravenous antibiotic therapy and treatment failure in infants with urinary tract infections. Pediatrics. 2010;126(2):196-203. (Retrospective cohort study; 12,333 patients)
  73. Finnell SM, Carroll AE, Downs SM. Technical report-Diagnosis and management of an initial UTI in febrile infants and young children. Pediatrics. 2011;128(3):e749-770. (Meta-analysis)
  74. White B. Diagnosis and treatment of urinary tract infections in children. Am Fam Physician. 2011;83(4):409-415. (Review)
  75. Weisz D, Seabrook JA, Lim RK. The presence of urinary nitrites is a significant predictor of pediatric urinary tract infection susceptibility to first- and third-generation cephalosporins. J Emerg Med. 2010;39(1):6-12. (Retrospective study; 173 patients)
  76. Paschke AA, Zaoutis T, Conway PH, et al. Previous antimicrobial exposure is associated with drug-resistant urinary tract infections in children. Pediatrics. 2010;125(4):664-672. (Retrospective cohort study; 533 patients)
  77. Hodson EM, Willis NS, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 2007(4):Cd003772. (Systematic review)
  78. Bocquet N, Sergent Alaoui A, Jais JP, et al. Randomized trial of oral versus sequential IV/oral antibiotic for acute pyelonephritis in children. Pediatrics. 2012;129(2):e269-e275. (Prospective randomized controlled trial; 171 patients)
  79. Michael M, Hodson EM, Craig JC, et al. Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Cochrane Database Syst Rev. 2003(1):Cd003966. (Cochrane review)
  80. Schnadower D, Kuppermann N, Macias CG, et al. Febrile infants with urinary tract infections at very low risk for adverse events and bacteremia. Pediatrics. 2010;126(6):1074- 1083. (Retrospective study; 1895 patients)
  81. John U, Kemper MJ. Urinary tract infections in children after renal transplantation. Pediatr Nephrol. 2009;24(6):1129-1136. (Review)
  82. Herthelius M, Oborn H. Urinary tract infections and bladder dysfunction after renal transplantation in children. J Urol. 2007;177(5):1883-1886. (Prospective case control study; 68 patients)
  83. Newman TB. The new American Academy of Pediatrics urinary tract infection guideline. Pediatrics. 2011;128(3):572-575. (Commentary)
  84. Hewitt IK, Zucchetta P, Rigon L, et al. Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian Renal Infection Study Trials. Pediatrics. 2008;122(3):486-490. (Randomized, prospective, controlled; 287 patients)
  85. Shaw KN. Call for a rational approach for testing for urinary tract infection as a source of fever in infants. Ann Emerg Med. 2013;61(5):566-568. (Review commentary)
  86. Gauthier M, Chevalier I, Sterescu A, et al. Treatment of urinary tract infections among febrile young children with daily intravenous antibiotic therapy at a day treatment center. Pediatrics. 2004;114(4):e469-476. (Prospective controlled study; 291 patients)
  87. Dore-Bergeron MJ, Gauthier M, Chevalier I, et al. Urinary tract infections in 1- to 3-month-old infants: ambulatory treatment with intravenous antibiotics. Pediatrics. 2009;124(1):16-22. (Prospective cohort study; 118 patients)
  88. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics. 1999;103(4 Pt 1):843-852. (Clinical practice guidelines)
  89. Salo J, Ikaheimo R, Tapiainen T, et al. Childhood urinary tract infections as a cause of chronic kidney disease. Pediatrics. 2011;128(5):840-847. (Retrospective review; 366 patients)
Already purchased this course?
Log in to read.
Purchase a subscription

Price: $449/year

140+ Credits!

Money-back Guarantee
Publication Information

Michael Reinberg, MD; Brian Rempe, MD

Publication Date

May 1, 2014

Get Permission

Get A Sample Issue Of Emergency Medicine Practice
Enter your email to get your copy today! Plus receive updates on EB Medicine every month.
Please provide a valid email address.