Clinical Predictors to Estimate the Probability of Urinary Tract Infection in Pediatric Febrile Patients Younger than 2 Years Old: Retrospective Analysis of Fever Registry

Background: Urinary tract infection (UTI) is a significant issue in febrile young patients because it may cause harm irreversible complications in kidneys. Early detection of urinary tract infection is crucial. Urinary culture is a gold standard to diagnose UTI, but it takes time. Clinical predictors are needed to predict UTI.

Objective: To find clinical predictors that can predict UTI.

Methods: We analyzed the registry of pediatric febrile patients less than 24 months of age collected in two pediatric emergency departments from Aug. 2016 to Feb. 2018. UTI was defined as 5 X 10⁴ in urine culture with bacteriuria or pyuria according to AAP criteria. Viral infection (VI) is defined as the case in which the bacterial infection is clearly not detected through the medical records and laboratory tests among the patients who were discharged with the diagnosis of viral infection. We analyzed the difference in demographic and clinical findings and performed a logistic regression analysis.

Results: There were 1003 (74.2%) patients in VI group and 348 (25.8%) patients in UTI group. UTI group had more males, younger, had a history of renal diseases, and had fewer rashes. There was no significant difference on body temperature, but fever duration of UTI group was shorter than that of VI group (31.7 ± 34.1 hours vs. 37.8 ± 47.2 hours, p=0.03). The logistic regression revealed that the likelihood of UTI was greater in men, when less than 12 months of age, when the amount of food is reduced by 50% or more, and if a rash is present, it is unlikely to be a urinary tract infection.

Conclusion: The likelihood of urinary tract infection increases with men, when less than 12 months, when the amount of food is reduced by 50% or more, and decreases when there is a rash.