One-Month-Old UTI Patient

“The urinalysis in this infant is suggestive of a urinary tract infection, although infants may have no abnormalities noted on initial urinalysis.7,8 The risk of bacteremia in infants under 60 days with documented urinary tract infection is significant. A number of studies support the need to treat infants less than 30 days with parenteral antibiotics.9-14 Addition of C-reactive protein testing at this time does not aid in distinguishing those who are bacteremic in this age group.15 The often quoted study by Hoberman of 306 children included only 13 under the age of two months.16 Of the 13 reported positive blood cultures, 10 were in children under age six months. Daily intramuscular ceftriaxone treatment would cover a majority of the typical neonatal UTI organisms, can be administered in the outpatient setting, and is proven to be as effective as intravenous delivery. The clinical response to bacteremia is, however, unpredictable in young infants. The sepsis potential in this infant requires admission for physiologic monitoring and support as needed.

“Final, but not inconsequential, concerns are barriers to follow-up. These include parental experience and coping skills with feeding and monitoring an ill infant, ability to educate on the illness and reasons for follow-up, transportation, and operational issues, such as weekend clinic hours or holiday office closures. For the index patient these issues are overshadowed by the clinical criteria for admission but would be of great importance for discharge.”

Conclusion

Based on these responses, admitting a suspected UTI patient on the basis of age alone, as suggested by Santen and Altieri, is likely inappropriate. Many other factors must be weighed and would likely indicate admission for the patient in the scenario, regardless of the infant’s age. In short, until there’s better evidence for age-based admission criteria, clinical judgment based on the individual patient presentation must continue to drive care and treatment decisions.

Keri Losavio is a medical journalist with more than 10 years’ experience.

References

1. UTI Guideline Team, Cincinnati Children’s Hospital Medical Center. “Evidence based clinical practice guideline for children 12 years of age or less with acute first time urinary tract infection.” www.cincinnatichildrens.org/svc/dept-div/health-policy/ev-based/uti.htm. Guideline 7, pages 1–20, April 2005.
2. Hoberman A, Wald ER. Treatment of urinary tract infections. Pediatr Infect Dis J. 1999;18(11):1020–1021.
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