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Inpatient Management of Urinary Tract Infections in Infants and Young Children

Consultations

Consider urology consultation if the RUS, VCUG, voiding history, or examination demonstrated concern for significant genitourinary abnormalities, abnormal voiding function or neurogenic bladder (23,32). Consider infectious disease consultation if the patient is not responding to conventional therapy without obstruction, unusual organisms are identified, or the patient is having recurrent urinary tract infections in the presence of normal urological structure and function.

Discharge Criteria and Processes

Consider discharge under the following conditions:

  • The patient is comfortable and tolerating oral fluids well.
  • The patient has been afebrile or has significantly decreasing fever for 24 hours.
  • Appropriate radiological studies and consultations have been completed or arranged for as an outpatient.
  • For patients requiring parenterally administered medications at home, long-term IV access must be obtained to assessment of home care service availability, benefits, family home resources, and caregiver education completed.
  • Appropriate prophylactic antibiotic prescription has been given to the caregiver with education on use after completion of acute antibiotic therapy. Prophylactic antibiotics should be administered until imaging studies have been completed and assessed.

Conclusion

UTI is a common bacterial infection requiring hospital admission for infants and young children. Admission decisions should take into consideration goals for inpatient care and special age or clinical circumstances. Treatment mode and duration must address avoidance of both acute and chronic complications. Radiologic studies offer both anatomic view and functional information. Clinical relevance of scars, utility of radiologic studies, and value of inflammatory markers are some of the many areas requiring further study.

References

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