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Testing for Urinary Tract Infection in the Influenza/Respiratory Syncytial Virus–Positive Febrile Infant Aged 2 to 12 Months

Schlechter Salinas, Anna Kathleen MD*; Hains, David S. MD†,§; Jones, Tamekia PhD‡,§; Harrell, Camden BS‡,§; Meredith, Mark MD§

doi: 10.1097/PEC.0000000000001073
Original Articles

Objective Infants 12 months or younger with influenza and respiratory syncytial virus (RSV) commonly present to the emergency department (ED) with fever. Previous publications have recommended that these patients have a urinalysis and urine culture performed. We aimed to assess the prevalence of urinary tract infection (UTI) in febrile RSV/influenza positive infants aged 2 to 12 months presenting to the ED. We also examined whether the 2011 American Academy of Pediatrics (AAP) UTI clinical practice guidelines could be used to identify patients at lower risk of UTI.

Methods This was a retrospective chart review examining all infants aged 2 to 12 months with a documented fever of higher than 38°C who presented to our ED from 2009 to 2013 and tested positive for influenza and/or RSV.

Results One thousand seven hundred twenty-four patients were found to meet our inclusion criteria. Of these, 98 were excluded because of known urinary tract anomaly or systemic antibiotic use in the 24 hours preceding evaluation. Of those patients remaining, 10 (0.62%) of 1626 had positive urine cultures (95% confidence interval, 0.3%–1.1%), and 8 (0.49%) of 1626 (95% confidence interval, 0.2%–0.97%) had positive urine cultures with positive urinalyses as defined in the 2011 AAP UTI clinical practice guidelines. All subjects with positive urine cultures as defined by the AAP had risk factors for UTI that placed their risk for UTI above 1%.

Conclusions Our population of 2- to 12-month-old febrile infants with positive influenza/RSV testing, who did not have risk factors to make their risk of UTI higher than 1%, may not have required evaluation with urinalysis or urine culture.

From the *Pediatric Emergency Medicine Fellowship, Dell Children's Medical Center of Central Texas, University of Texas at Austin Dell Medical School, Austin, TX

Innate Immunity Translational Research Center

Children's Foundation Research Institute

§Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.

Disclosure: The authors declare no conflict of interest.

Reprints: Anna Kathleen Schlechter Salinas, MD, 3921 Briones Street Austin, TX 78723 (e-mail:

Online date: March 9, 2017

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