Urinary Tract Infection in Outpatient Febrile Infants Younger Than 30 Days of Age

A 10-Year Evaluation

William Bonadio, MD; Gary Maida, MD


Pediatr Infect Dis J. 2014;33(4):342-344. 

In This Article


A total of 670 febrile infants ≤30 days of age presented to the ED during the 10-year study period; 19 medical records (3%) did not give urine culture results and these cases were excluded. Table 1 shows clinical characteristics of the 651 study patients. All had bladder catheterized-collected UC performed; of the 100 infants meeting the criteria for UTI, 87 had a urine dispstick test performed and 95 had RUS performed before hospital discharge. No patient received antibiotics before ED evaluation. All patients had a rectal temperature measurement, LP with CSF analysis and CBC/blood culture performed.

Urine cultures were positive for the following bacterial pathogens: Escherichia coli (71), Enterococcus (10), Klebsiella neumoniae (7), Klebsiella oxytoca (3) Enterobacter cloacae (3), Group B Streptococcus (1), Pseudomonas aeruginosa (1), Staphylococcus aureus (1), Staphylococcus coagulase-negative (1), Serratia marcescens (1) and viridans streptococci (1). The distribution of urine culture colony counts with UTI were 10–20,000 CFU/mL (5), 20–49,000 CFU/mL (17), 50–75,000 CFU/mL (39) and ≥100,000 CFU/mL (39). All 4 cases of urosepsis had E. coli UTI and bacteremia.

Of 95 patients who had renal ultrasound (RUS) imaging, 45 (47%) had a renal anatomic abnormality, including 19 with pelviectasis and 26 with hydronephrosis (graded as mild in 12 cases and moderate in 14 cases). A VCUG was performed in 21/26 patients with hydronephrosis; 5 (24%) were positive for VUR (E. coli in 1 case, Enterobacter sp. in 2 cases and Klebsiella sp. in 2 cases); of these, 1 was grade II, 2 were grade III, 1 was grade IV and 1 was grade V.