Pathway for the Evaluation and Treatment of Children with Febrile UTI

Definition of a UTI

Abnormal UA AND growth of a urinary pathogen

SPECIMEN (cfu/mL) DEFINITE (cfu/mL) POSSIBLE (cfu/mL)
Catheterization > 50, 000 cfu/mL > 10,000 cfu/mL
Clean-catch > 100,000 cfu/mL > 50,000 cfu/mL

Interpreting UA and Urine Culture Results and Follow-up Recommendations

UA RESULTS CULTURE RESULTS RECOMMENDATION FOLLOW-UP
UA meets criteria for empiric treatment
LE ≥ 2+ or nitrite or
≥5 WBC/hpf AND bacteriuria
Cfu criteria met for definite UTI
Cfu criteria met for possible UTI
Contaminant or negative
Check sensitivities, treat 7-10 days
Check sensitivities, treat 7-10 days
Stop treatment
RBUS
RBUS
None
UA positive but does not meet empiric treatment criteria
(trace or LE 1+)
Cfu criteria met for definite UTI
Cfu criteria met for possible UTI
Check sensitivities, treat 7-10 days
Check patient
  • Febrile, check sensitivities, treat 7-10 days
  • Afebrile, no treatment
RBUS
RBUS
None
UA negative Cfu criteria met for definite or possible UTI Check patient
  • Febrile, repeat specimen
  • Afebrile, no treatment (asymptomatic bacteriuria)
None at this time
Contaminant No treatment None

Urine Pathogens

  • E. coli, Proteus sp.
  • Enterococcus sp.
  • Pseudomonas sp.
  • Serratia sp.
  • Corynebacterium Urealyticum
  • Klebsiella sp.
  • Enterobacter sp.
  • Group B streptococci
  • Staphylococcus aureus

Common Contaminants

ALL urine cultures need careful follow-up

Patients treated empirically

Positive urine cultures

Negative urine cultures

Inform family that the patient did not have a UTI