Outpatient management of young febrile infants with urinary tract infections

David Schnadower, Nathan Kuppermann, Charles G. Macias, Stephen B. Freedman, Dewesh Agrawal, Jingnan Mao, Peter S. Dayan

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: Controversy exists regarding the disposition of young febrile infants who present to emergency departments (EDs) with urinary tract infections (UTIs). In a large multicenter cohort of such patients, we aimed to determine the variation in patient disposition and clinical factors independently associated with outpatient management. Methods: Secondary analysis of a retrospective study of infants 29 to 60 days with fever (-38.0C), urinalysis finding, and culture-proven UTIs presenting to 20 North American EDs belonging to the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. We determined independent factors associated with outpatient management. Results: Of 1764 infants with UTIs, 132 (7.5%) were discharged home from the ED. The proportion of infants managed as outpatients varied among sites (0%-20.0%). Of the 132 infants, 29 (22.0%) were subsequently hospitalized after culture results were known, including 5 patients with bacteremia. None of the 107 patients initially discharged from the ED for whom outcomes were known had adverse events (0%; 95% CI, 0%-2.7%). On multivariable regression and generalized estimated equations analyses, only clinical site, presence of upper respiratory tract infection symptoms, absence of vomiting, and having fewer than 10 white blood cells per microliter on cerebrospinal fluid examination were independently associated with discharge from the ED. Clinical site was the factor most highly associated with outpatient management (odds ratio, 8.8; 95% confidence interval, 5.2-15.0). Conclusions: There is substantial practice variation regarding the disposition of febrile infants 29 to 60 days of age with UTIs. Institutional practice is the strongest predictor of outpatient management. Further evidence is needed to guide the management of non-toxic-Appearing young febrile infants with UTIs.

Original languageEnglish (US)
Pages (from-to)591-597
Number of pages7
JournalPediatric Emergency Care
Volume30
Issue number9
StatePublished - 2014

Fingerprint

Urinary Tract Infections
Fever
Outpatients
Hospital Emergency Service
Institutional Practice
Urinalysis
Bacteremia
Respiratory Tract Infections
Vomiting
Cerebrospinal Fluid
Leukocytes
Retrospective Studies
Odds Ratio
Confidence Intervals
Pediatrics
Research

Keywords

  • bacteremia
  • hospitalization
  • infants
  • length of stay
  • outpatient management
  • urinary tract infections

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

Cite this

Schnadower, D., Kuppermann, N., Macias, C. G., Freedman, S. B., Agrawal, D., Mao, J., & Dayan, P. S. (2014). Outpatient management of young febrile infants with urinary tract infections. Pediatric Emergency Care, 30(9), 591-597.

Outpatient management of young febrile infants with urinary tract infections. / Schnadower, David; Kuppermann, Nathan; Macias, Charles G.; Freedman, Stephen B.; Agrawal, Dewesh; Mao, Jingnan; Dayan, Peter S.

In: Pediatric Emergency Care, Vol. 30, No. 9, 2014, p. 591-597.

Research output: Contribution to journalArticle

Schnadower, D, Kuppermann, N, Macias, CG, Freedman, SB, Agrawal, D, Mao, J & Dayan, PS 2014, 'Outpatient management of young febrile infants with urinary tract infections', Pediatric Emergency Care, vol. 30, no. 9, pp. 591-597.
Schnadower D, Kuppermann N, Macias CG, Freedman SB, Agrawal D, Mao J et al. Outpatient management of young febrile infants with urinary tract infections. Pediatric Emergency Care. 2014;30(9):591-597.
Schnadower, David ; Kuppermann, Nathan ; Macias, Charles G. ; Freedman, Stephen B. ; Agrawal, Dewesh ; Mao, Jingnan ; Dayan, Peter S. / Outpatient management of young febrile infants with urinary tract infections. In: Pediatric Emergency Care. 2014 ; Vol. 30, No. 9. pp. 591-597.
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