Can absence of pyuria exclude urinary tract infection in febrile infants? About 2011 AAP guidelines on UTI

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Abstract

Background:

The aim of this study was to describe clinical and laboratory characteristics of urinary tract infection (UTI) without significant pyuria in young children aged 2–24 months.

Methods:

The subjects consisted of infants and young children with febrile UTI treated at Pusan National University Children's Hospital, Korea. Group A included 283 patients with definite UTI who fulfilled the revised American Academy of Pediatrics diagnostic criteria, and group B included 19 patients with presumed UTI who had significant culture of uropathogens without pyuria, bacteriuria or other focus of infection.

Results:

Duration of fever before hospital visit in group B was significantly shorter than in group A (17.7 ± 14.0 vs 34.5 ± 30.7 h). Most patients in group B (17/19, 89.5%) came to the hospital within 24 h of onset of fever. Acute scintigraphic lesions were found in 47.8% of patients in group A and 50% in group B. Underlying urological abnormalities such as vesicoureteral reflux and obstructive uropathy were found in 24.5% of patients in group A and in 33.3% of patients in group B (P = 0.74).

Conclusions:

Clinicians cannot exclude UTI on the absence of pyuria in young children aged 2–24 months.

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