One previous study recommended oral and outpatient management for those infants aged 60–90 days with urinary tract infection (UTI) meeting the low-risk criteria identified: to be well-appearing and to have a procalcitonin value of < 0.7 ng/mL. A retrospective study was conducted, including infants aged 29 to 90 days with UTI from 2014 to 2019, to validate these low-risk criteria identified and determine the adherence to the new algorithm for managing these patients at the Emergency Department. Two hundred one patients were included; 105 (52.2%) were aged 60 to 90 days. Twelve (6%, 95% CI 3.4–10.1%) had bacteremia. One hundred thirty-six (67.7%) infants met low-risk criteria; none had a positive blood culture (0%, 95% CI 0–2.7%). Overall protocol adherence was 90.6%. One hundred and forty-four (71.6%) infants were admitted to the hospital; all patients meeting high-risk criteria were hospitalized. Among the 57 (28.4%) infants initially sent home, 4 (7.0%) required later hospital admission.
Conclusions: A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia. Outpatient management with appropriate follow-up is safe for these infants.
What is Known:|
• Patients under 2–3 months of age with a presumptive urinary tract infection (UTI) are commonly hospitalized because of concerns regarding concomitant bacteremia.
What is New:|
• A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia. Outpatient management with appropriate follow-up is safe for these infants.
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Raw data are available upon reasonable request (correspondence author).
Group B Streptococcus
Intensive care unit
Negative predictive value
Pediatric Assessment Triangle
Serious bacterial infection
Urinary tract infection
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The study was approved by the hospital’s Ethics Committee (PIC-65–19). Since the data were extracted from a registry, the information contained in it was anonymous, and since no interventions were performed on patients, informed consent was not required or requested.
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Communicated by Nicole Ritz
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Hernández-Bou, S., Trenchs, V., Soler-Garcia, A. et al. Outpatient and oral management is suitable for infants 60–90 days old with urinary tract infections at low risk of bacteremia. Eur J Pediatr (2021). https://doi.org/10.1007/s00431-021-04224-7
- Prediction model
- Urinary tract infection
- Young infant