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HIGH-YIELD FACTS

  • Signs and symptoms of a urinary tract infection (UTI) may be nonspecific in neonates and young infants.

  • Urinary catheterization is the preferred method for obtaining a urine specimen in children who are not toilet trained.

  • Sterile urine cultures (via catheterization or suprapubic aspiration) should be obtained prior to the administration of antibiotics in ill-appearing children and neonates.

  • Up to 9.8% of infants younger than 3 months of age with fever and UTI are also bacteremic; blood cultures should be obtained in these infants.

  • The antibiotic choice for a UTI must be guided by local resistance patterns and the effectiveness against Escherichia coli.

  • Children with a history of a UTI should be cautioned to seek medical care in the first 48 hours of subsequent febrile illnesses to evaluate for a recurrent UTI.

  • Approximately 90% of renal stones are radiopaque and can be managed medically.

  • An infected obstructing urinary stone is a urological emergency that demands emergent urinary tract decompression.

  • Computerized tomography (CT) has traditionally been the imaging modality of choice for the diagnosis of renal stone, but an ultrasound-first approach is increasingly being utilized.

  • Recurrence rates of urolithiasis are high in children and therefore require a thorough metabolic evaluation for the cause.

URINARY TRACT INFECTIONS

Urinary tract infections (UTIs) are a frequent cause of fever in infants and young children, accounting for more than 1.1 million visits annually, and occurring in 2.4% to 2.8% of all children.1,2 The prevalence of UTIs varies with age and gender. The prevalence of UTIs in febrile children less than 2 years of age is 7%, and in children less than 5 years of age is 3.4%.3,4 Urinary tract infections are divided into two overlapping categories: lower UTIs, which are limited to cystitis and urethritis, and upper UTIs, which include ureteritis, pyelitis, and pyelonephritis.5 Pyelonephritis can cause renal scarring, which is thought to lead to hypertension and renal failure later in life; the early recognition and treatment of an upper tract infection is thought to reduce the risk of scarring.5–8 However, the recent literature supporting this is controversial.9–13

Concomitant bacteremia may complicate a febrile UTI.14 In the age of effective vaccines against Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, a UTI is the most common serious bacterial illness (SBI) of young infants.14 However, the natural history of a UTI is different than other causes of SBI, since children generally defervesce after 24 hours and have a benign course.15 A young age is the most significant risk factor for developing associated bacteremia. In infants less than 3 months of age, the rate of bacteremia with UTI has been reported between 1.5% and 9.8%. After 3 months of age, the risk of associated bacteremia decreases to less than 5%.14,16,17

There are risk factors for developing a ...

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