Objectives
            Objectives
    Define Urinary Tract Infection (UTI)
    Define Urinary Tract Infection (UTI)
    List antibiotic treatment options for 
    List antibiotic treatment options for 
    UTI
    UTI
    List the workup after a first febrile 
    List the workup after a first febrile 
    UTI
    UTI
    Be familiar with the rationale for 
    Be familiar with the rationale for 
    using prophylactic antibiotics after 
    using prophylactic antibiotics after 
    the first febrile UTI
    the first febrile UTI
     Pediatric UTIs and EBM
     Pediatric UTIs and EBM
     Up to 7% of girls and 2% of boys 
      Up to 7% of girls and 2% of boys 
      experience a symptomatic culture-proven 
      experience a symptomatic culture-proven 
      UTI prior to 6 years of age.
      UTI prior to 6 years of age.
     Of febrile neonates, up to 7% have UTIs.
      Of febrile neonates, up to 7% have UTIs.
       (See Fever without a source guidelines)
        (See Fever without a source guidelines)
     Most UTIs in children are from 
      Most UTIs in children are from 
      ascending bacteria
      ascending bacteria
       E. coli (60-80%), Proteus, Klebsiella, 
        E. coli (60-80%), Proteus, Klebsiella, 
        Enterococcus, and coag. neg. staph.
        Enterococcus, and coag. neg. staph.
              Epidemiology
               Epidemiology
     The overall prevalence of UTI is 
      The overall prevalence of UTI is 
     approximately 5 percent in febrile infants 
      approximately 5 percent in febrile infants 
     but varies widely by race and sex. 
      but varies widely by race and sex. 
     Caucasian children had a two- to fourfold 
      Caucasian children had a two- to fourfold 
     higher prevalence of UTI as compared to 
      higher prevalence of UTI as compared to 
     African-American children 
      African-American children 
     Females have a two- to fourfold higher 
      Females have a two- to fourfold higher 
     prevalence of UTI than do circumcised males 
      prevalence of UTI than do circumcised males 
     Caucasian females with a temperature of 39 
      Caucasian females with a temperature of 39 
     ºC have a UTI prevalence of 16 percent
      ºC have a UTI prevalence of 16 percent
       Approximate probability of urinary tract infection 
       Approximate probability of urinary tract infection 
               in febrile infants and young children by 
               in febrile infants and young children by 
                            demographic group 
                            demographic group 
      Demographic group        Prevalence (pretest     Odds
                               probability)
      Circumcised boys >1 yr   <1 percent              .01 (1 in 100)
      Circumcised boys <1 yr   2 percent               .02 (1 in 50)
      Black girls              4 percent               .04 (1 in 25)
      Uncircumcised boys <2  8 percent                 .09 (1 in 12)
      yr
      White girls <2 yr        16 percent              .19 (1 in 5)
            Definition of UTI on 
            Definition of UTI on 
                           culture
                           culture
     Method of urine collection     Diagnostic threshold
     Clean-catch in voiding girls   100,000 CFU per mL
                                    10,000 – 100,000   repeat 
                                    culture
     Clean-catch in voiding boys    10,000 CFU per mL
     Catheter                       10,000 CFU
                                    1,000 – 10,000  repeat culture
     Suprapubic aspiration          Any colonies of GNRs
                                    More than a few thousand GPCs