Original Contributions
Utility of blood cultures in febrile children with UTI*

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Abstract

The objective of the study was to define the prevalence of bacteremia in febrile children <18 years of age diagnosed to have acute urinary tract infection (UTI). Retrospective chart review of patients diagnosed to have a UTI in the emergency department (ED) of an urban, tertiary care children's hospital was conducted Seven hundred forty-four children were discharged or admitted from the ED with a diagnosis of UTI during the study period. Thirty-six (4.8%) patient records were unavailable for review; 343 met inclusion criteria. Two hundred forty-nine patients (72.8%) had a history of fever. Blood cultures were performed on 183 (53.4%) patients. Of febrile patients, 178 (71.5%) had a blood culture performed. Seventeen of 183 (9.3%) blood cultures were positive. All (17/178, 9.5%) positive blood cultures were obtained from febrile patients. Seven of the positive blood cultures were considered to be contaminated. The prevalence of true bacteremia in febrile patients was 5.6%. All 10 patients with a true pathogen recovered from the blood culture had the same organism in their urine culture. The prevalence of bacteremia in patients younger than 2 months was 22.7% and in patients between the ages of 2 months and 36 months, 3.0%. Patients with a positive blood culture were more likely to be younger, to have been hospitalized and to have had a longer duration of hospitalization. No difference was found between patients with a positive blood culture and those without in regards to the number of days of illness before presentation, time to defervescence and mean white blood cell count. Bacteremia in children with UTI is most common in very early infancy. Children with UTI between the ages of 2 months and 12 years appear to have a low risk of bacteremia. Children who are bacteremic are likely to have identical organisms with identical antimicrobial sensitivities in both the urine and blood culture. (Am J Emerg Med 2002;20:271-274. Copyright 2002, Elsevier Science (USA). All Rights reserved.)

Section snippets

Study design, setting, and population

A retrospective cohort study was conducted. Children between the ages of 0 and 18 years presenting to the ED of an urban, tertiary care children's hospital between August 1, 1996 and July 31, 1998 were eligible for study if, on review, they had (1) a urine culture that grew at least 100,000 colony-forming units (cfu) per ml of a single pathogen in a clean catch specimen or 50,000 cfu/mL of a single pathogen in a catheterized or suprapubic specimen or (2) more than one organism in their urine

Results

Seven hundred forty-four children were discharged or admitted from the ED with a diagnosis of urinary tract infection or pyelonephritis during the study period. Thirty-six (4.8%) patient records were unavailable for review. Of the remaining cases, 343 met inclusion criteria. Three hundred sixty-five patients were excluded because they had a negative (n = 228) or missing urine culture (n = 31), had received antibiotics within the previous week (n = 103), or were older than 18 years of age (n =

Discussion

Febrile children presenting to the ED often have an occult source of infection. Accordingly, laboratory evaluation, including a urinalysis, is undertaken to identify the source of the fever. As UTI is a frequent cause of fever in children, especially infant girls, the performance of a urinalysis is appropriate. When a diagnosis of UTI is suspected based on the findings of the urinalysis, it is commonplace to also perform a blood culture. Documenting bacteremia would be important if the presence

Acknowledgements

The authors thank Dr Ellen Wald for her help in the preparation of this manuscript.

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*

Address reprint requests to Raymond Pitetti, MD. Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine/Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213. Email: [email protected]

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Copyright © 2002 Published by Elsevier Inc.