Comparison of urinary tract infection rates among 2- to 12-month-old febrile infants with RSV infections using 1999 and 2011 AAP diagnostic criteria

Clin Pediatr (Phila). 2014 Jul;53(8):742-6. doi: 10.1177/0009922814529015. Epub 2014 Mar 28.

Abstract

Background: Infants with RSV infections have been found to have a clinically significant rate of urinary tract infections (UTIs). The American Academy of Pediatrics (AAP) published a revised Clinical Practice Guideline on UTIs in 2011, which includes major changes in diagnostic criteria for UTIs. Past research has been done using previous diagnostic criteria. The objective of the study is to assess the rate of UTIs in febrile infants with respiratory syncytial virus (RSV) infections according to the 2011 revised AAP Diagnostic Criteria and compare the rate of UTIs against the 1999 AAP Diagnostic Criteria.

Methods: A retrospective comparative study of febrile infants (2-12 months) with RSV infections admitted to the Inpatient Pediatric unit of Lincoln Medical and Mental Center, Bronx, NY, from September through April 2006 to 2012. We applied the AAP's 1999 and 2011 diagnostic criteria for UTIs separately to assess the rates of UTIs.

Results: A total of 359 RSV-positive febrile patients who were investigated for UTIs were enrolled. Pyuria was found in 11.1% (40/359), positive urine culture 10 000 to 50 000 was found in 1.4% (5/359) and ≥50 000 in 4.7% (17/359). The rate of UTIs using AAP's 1999 criteria was 6.1% (22/359), and using the 2011 criteria the rate was 1.1% (4/359). The rate of UTIs was significantly different between the 2 groups (odds ratio [confidence interval] = 0.17 [0.05, 0.5], P = .001).

Conclusions: The rate of UTIs in RSV-positive febrile infants is very low (1.1%) with the 2011 AAP diagnostic criteria. Previously described increased risk of UTIs may represent asymptomatic bacteriuria or contaminated specimens.

Keywords: RSV; fever; infants; respiratory syncytial virus; urinary tract infection.

Publication types

  • Comparative Study

MeSH terms

  • Bacteriuria / diagnosis
  • Bacteriuria / epidemiology
  • Cohort Studies
  • Comorbidity
  • Confidence Intervals
  • Female
  • Fever / diagnosis*
  • Fever / epidemiology
  • Fever / therapy
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Infant
  • Male
  • Odds Ratio
  • Practice Guidelines as Topic / standards*
  • Prognosis
  • Respiratory Syncytial Virus Infections / diagnosis*
  • Respiratory Syncytial Virus Infections / epidemiology
  • Respiratory Syncytial Virus Infections / therapy
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Urinalysis
  • Urinary Tract Infections / diagnosis*
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / therapy