Pathway for the Evaluation and Treatment of Children with Febrile UTI

Goals and Metrics
Patient Education
Quality Story
Children with/at Risk for Febrile UTI
History and Physical Exam
Risk Factors for UTI and Screening Recommendations
> 56 DAYS - NOT TOILET TRAINED
FULLY TOILET TRAINED – 18 YRS
Female Risk Factors*
  • Non-black
  • T ≥ 39°C
  • Fever ≥ 2 days
  • No source
  • < 12 months
Number of Risk Factors Present
  • Consider screening ≥ 3
  • Recommend screening ≥ 4
*Recommend screening if prior
history of UTI, fever ≥ 2 days
*For infants 2-3 months of age, consider lower threshold for screening
Male Risk Factors*
  • Non-black
  • T ≥ 39°C
  • Fever ≥ 2 days
  • No source
  • < 6 months
Number of Risk Factors Present
Circumcised
  • Consider screening ≥ 3
  • Recommend screening ≥ 4
Uncircumcised
  • Consider screening ≥ 2
  • Recommend screening ≥ 3
All Patients
  • Symptoms referable to urinary tract
  • Prior history of UTI, fever ≥ 2 days
  • Prolonged fever (≥ 5 days)
  • Recommend screening for any of the above factors
Urine Collection Methods
When RN Should Consider Placing a Bag for Urine Collection
Urine Testing
Empiric Treatment Based on UA Results
IV vs PO Therapy
Antibiotic Recommendations
Definition of UTI
Follow-up Recommendations
Imaging, Prophylaxis, Referral Recommendations
Posted: June, 2011
Revised: October 2011, August 2014, October 2017 (Reviewed), June 2018
Authors: K. Shaw, MD, N. Plachter, CRNP, J. Lavelle, MD, T. Kolon, MD, M. Carr, MD, R. Keren, MD, R. Patel, MD, M. Dunne, MD, J. Kim, MD, J. Gerber, MD, M. Pradhan, MD, K. Ota, MD, C. Jacobstein MD, K. McGowan, PhD, T. Metjian, PharmD, M. Blackstone, MD