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High-Yield Facts

  • Signs and symptoms of urinary tract infection (UTI) may be nonspecific in young infants, and even older children may not complain of dysuria.

  • In the evaluation of infants and children with fever without a source, up to 7% of patients will be found to have a UTI.

  • Urinary catheterization is the method of choice for obtaining the urine specimen in febrile infants and young children.

  • Presence of bacteria on a Gram stain or nitrites and leukocyte esterase on urine dipstick are highly indicative of a UTI, but urine culture is the gold standard for diagnosis.

  • Greater than 5% of infants younger than 3 months with fever and UTI are bacteremic.

  • Antibiotic choice for UTI must be guided by local resistance patterns and effectiveness against Escherichia Coli.

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

  • Computed tomography (CT) scan of the abdomen without contrast is the test of choice for the evaluation of children with renal stones; however, ultrasound may be used to evaluate children with recurrent renal stones.

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

Urinary Tract Infection

Urinary tract infection (UTI) is 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 It is important to identify and treat UTIs because this may lead to the diagnosis of unsuspected anomalies of the urinary tract, and, thus, the prevention of morbidity associated with progression to pyelonephritis as well as long-term complications of renal scarring such as chronic renal failure and hypertension. Fever may be the sole manifestation of a UTI. Febrile children younger than 24 months with no other identifiable source for fever on examination were found to have a 7% probability of UTI (range <1%–16%), which is higher than the likelihood of occult bacteremia (<1%) among fully immunized children.3,4 The prevalence of UTI varies with age and gender. Studies show a 2- to 3-fold higher risk of UTI in febrile, uncircumcised male infants than age-matched females and a 10-fold greater risk of UTI than circumcised males in the first 3 months of life.4,5 After 3 months of age, febrile female infants have a higher prevalence (2%–10%) of UTIs compared to their male counterparts with circumcised males having less than a 0.5% chance of UTI after 6 months of age.4 Race may also play a role in the incidence of UTI with Whites showing a higher prevalence (8% vs. 2.7%) compared with African Americans.4

Classic symptoms of UTI such as dysuria, urgency, increased urinary frequency, and flank pain are less frequently reported in children than in adults.4 Young children, in particular, are more likely to present with nonspecific symptoms. It is important to ...

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