Published online August 31, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. 644-648 (doi:10.1542/peds.2004-1825)

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

Joseph J. Zorc, MD^*, Deborah A. Levine, MD, Shari L. Platt, MD, Peter S. Dayan, MD, Charles G. Macias, MD, MPH^||, William Krief, MD^¶, Jeffrey Schor, MD^#, David Bank, MD^**, Kathy N. Shaw, MD, MSCE^*, Nathan Kuppermann, MD, MPH for the Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics

^* Department of Pediatrics, University of Pennsylvania School of Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Departments of Pediatrics and Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center, New York, New York
Department of Pediatrics and Division of Emergency Medicine, The Children’s Hospital of New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, New York
^|| Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
^¶ Department of Pediatrics, Division of Emergency Medicine, Long Island Jewish Hospital–Schneider’s Children’s Hospital, New Hyde Park, New York
^# Departments of Pediatrics and Emergency Medicine, New York Hospital–Medical Center of Queens, New York, New York
^** Departments of Pediatrics and Emergency Medicine, New York Presbyterian Hospital–New York Weill Cornell Medical Center, New York, New York
Departments of Emergency Medicine and Pediatrics, University of California, Davis, School of Medicine, Davis, California

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.

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Key Words: fever • infant • urinary tract infection

Abbreviations: UTI, urinary tract infection • SBI, serious bacterial infection • ED, emergency department • YOS, Yale Observation Scale • RSV, respiratory syncytial virus • cfu, colony-forming units • OR, odds ratio • CI, confidence interval

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Accepted Dec 6, 2004.

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