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Indications for urinalysis and urine culture in febrile children age ≥1 month with suspected UTI and no abnormalities of the urinary tract[1,2]

Indications for urinalysis and urine culture in febrile children age ≥1 month with suspected UTI and no abnormalities of the urinary tract[1,2]
Age, sex, and circumcision status Indications for urine sample
1 to <2 months
  • Females and males (circumcised or uncircumcised)
  • Fever ≥38°C
2 through 11 months
  • Females and uncircumcised males
  • Fever ≥38°C
  • Circumcised males
  • Fever ≥38°C and any of the following combinations:
    • No other source of fever* and history of UTI
    • No other source of fever*, maximum fever ≥39°C, and fever ≥48 hours
    • Other source of fever*, history of UTI, maximum fever ≥39°C, and fever ≥48 hours
12 through 23 months
  • Females and uncircumcised males
  • Any of the following combinations:
    • Fever ≥38°C and history of UTIΔ
    • Fever ≥38°C and no other source of fever*
    • Maximum fever ≥39°C and fever ≥48 hours
  • Circumcised males
  • The combination of no other source of fever*, maximum fever ≥39°C, history of UTI, and fever ≥48 hours
≥24 months
  • Females and uncircumcised males: ≥1 clinical finding
  • Circumcised males: ≥2 clinical findings
  • Clinical findings:
    • Dysuria
    • Frequency
    • New-onset incontinence
    • Abdominal pain
    • Back pain
    • Fever ≥39°C if no other source of fever is identified*
This table is meant for use with UpToDate content on UTI in children. The indications for obtaining urine samples correspond to a pretest probability of UTI ≥2% (ie, approximately 10 children need to be tested for every UTI detected, which are the thresholds used in UTICalc, available from the University of Pittsburgh).[1] Thresholds may vary depending on duration of symptoms, feasibility of follow-up, and parental views toward catheterization.
UTI: urinary tract infection.
* Other source of fever includes (but is not limited to) acute otitis media; pneumonia; meningitis; upper respiratory tract infection, gastroenteritis, bronchiolitis, or other viral syndrome.
¶ Documented UTI or UTI reported by caregiver.
Δ Although the pretest probability is <2% for female or uncircumcised children age 12 through 23 months with a history of UTI, maximum temperature <39°C, and fever <48 hours, children with a history of febrile UTI are at increased risk for renal scarring with recurrent UTI and we obtain a urine sample for urinalysis and urine culture in such children.
References:
  1. University of Pittsburgh. UTICalc version 3.0. Available at: https://uticalc.pitt.edu/ (Accessed on July 28, 2021).
  2. Shaikh N, Hoberman A, Hum SW, et al. Development and validation of a calculator for estimating the probability of urinary tract infection in young febrile children. JAMA Pediatr 2018; 172:550.
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