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Urine Testing and Urinary Tract Infections in Febrile Infants Seen in Office Settings
The Pediatric Research in Office Settings' Febrile Infant Study
Thomas B. Newman, MD, MPH;
Jane A. Bernzweig, PhD;
John I. Takayama, MD, MPH;
Stacia A. Finch, MA;
Richard C. Wasserman, MD, MPH;
Robert H. Pantell, MD
Arch Pediatr Adolesc Med. 2002;156:44-54.
Objective To determine the predictors and results of urine testing of young febrile
infants seen in office settings.
Design Prospective cohort study.
Setting Offices of 573 pediatric practitioners from 219 practices in the American
Academy of Pediatrics Pediatric Research in Office Settings' research network.
Subjects A total of 3066 infants 3 months or younger with temperatures of 38°C
or higher were evaluated and treated according to the judgment of their practitioners.
Main Outcome Measures Urine testing results, early and late urinary tract infections (UTIs),
and UTIs with bacteremia.
Results Fifty-four percent of the infants initially had urine tested, of whom
10% had a UTI. The height of the fever was associated with urine testing and
a UTI among those tested (adjusted odds ratio per degree Celsius, 2.2 for
both). Younger age, ill appearance, and lack of a fever source were associated
with urine testing but not with a UTI, whereas lack of circumcision (adjusted
odds ratio, 11.6), female sex (adjusted odds ratio, 5.4), and longer duration
of fever (adjusted odds ratio, 1.8 for fever lasting  24 hours) were not
associated with urine testing but were associated with a UTI. Bacteremia accompanied
the UTI in 10% of the patients, including 17% of those younger than 1 month.
Among 807 infants not initially tested or treated with antibiotics, only 2
had a subsequent documented UTI; both did well.
Conclusions Practitioners order urine tests selectively, focusing on younger and
more ill-appearing infants and on those without an apparent fever source.
Such selective urine testing, with close follow-up, was associated with few
late UTIs in this large study. Urine testing should focus particularly on
uncircumcised boys, girls, the youngest and sickest infants, and those with
persistent fever.
From the Departments of Epidemiology and Biostatistics (Dr Newman),
Pediatrics (Drs Newman, Bernzweig, Takayama, and Pantell), and Family Health
Care Nursing (Dr Bernzweig), University of California, San Francisco; Pediatric
Research in Office Settings, Center for Child Health Research, American Academy
of Pediatrics, Elk Grove Village, Ill (Ms Finch and Dr Wasserman); and the
Department of Pediatrics, University of Vermont College of Medicine, Burlington
(Dr Wasserman).
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