When to Check UA in RSV Positive Infants

Short Attention Span Summary

When to check pee in RSV
Children under 12 months with RSV or influenza who also have fever are often still tested for UTI based on prior research showing UTI prevalence of about 6%.  But this retrospective study found that in children 2-12 months with either RSV or influenza, the rate of concomitant UTI was only 0.62%.  And all of the children with positive urine cultures had risk factors for UTI, making their risk of UTI > 1%, according to the 2011 AAP UTI clinical practice guidelines.  They concluded that in children with <1% risk for UTI with positive RSV or influenza, that a UA/urine culture may not be needed.

Figure from AAP Guideline above. a = >1% risk regardless of other risk factors other than being uncircumcised. 

Figure from AAP Guideline above.
a = >1% risk regardless of other risk factors other than being uncircumcised. 

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Febrile children 2-12 months of age with RSV or influenza may still have UTI as a source of the fever.  This study suggests that we may be able to base urine testing on the patient's risk of UTI, with urine testing only in kids with > 1% risk.


Abstract

Pediatr Emerg Care. 2017 Mar 9. doi: 10.1097/PEC.0000000000001073. [Epub ahead of print]

Testing for Urinary Tract Infection in the Influenza/Respiratory Syncytial Virus-Positive Febrile Infant Aged 2 to 12 Months.

Schlechter Salinas AK1, Hains DSJones THarrell CMeredith M.

Author information:

1 From the *Pediatric Emergency Medicine Fellowship, Dell Children's Medical Center of Central Texas, University of Texas at Austin Dell Medical School, Austin, TX; †Innate Immunity Translational Research Center, and ‡Children's Foundation Research Institute, §Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.

Abstract

OBJECTIVE:

Infants 12 months or younger with influenza and respiratory syncytial virus (RSV) commonly present to the emergency department (ED) with fever. Previous publications have recommended that these patients have a urinalysis and urine culture performed. We aimed to assess the prevalence of urinary tract infection (UTI) in febrile RSV/influenza positive infants aged 2 to 12 months presenting to the ED. We also examined whether the 2011 American Academy of Pediatrics (AAP) UTI clinical practice guidelines could be used to identify patients at lower risk of UTI.

METHODS:

This was a retrospective chart review examining all infants aged 2 to 12 months with a documented fever of higher than 38°C who presented to our ED from 2009 to 2013 and tested positive for influenza and/or RSV.

RESULTS:

One thousand seven hundred twenty-four patients were found to meet our inclusion criteria. Of these, 98 were excluded because of known urinary tract anomaly or systemic antibiotic use in the 24 hours preceding evaluation. Of those patients remaining, 10 (0.62%) of 1626 had positive urine cultures (95% confidence interval, 0.3%-1.1%), and 8 (0.49%) of 1626 (95% confidence interval, 0.2%-0.97%) had positive urine cultures with positive urinalyses as defined in the 2011 AAP UTI clinical practice guidelines. All subjects with positive urine cultures as defined by the AAP had risk factors for UTI that placed their risk for UTI above 1%.

CONCLUSIONS:

Our population of 2- to 12-month-old febrile infants with positive influenza/RSV testing, who did not have risk factors to make their risk of UTI higher than 1%, may not have required evaluation with urinalysis or urine culture.

PMID: 28277411