Consider pediatric consult
Consider other source
Suprapubic tenderness alone OR 2 or more risk factors:
- White race
- Age < 12 months
- Temperature > 39 C (102.2 F)
- Fever > 24 hours
- No apparent source
- History of UTI
Pyuria present on urine dip?
Consider other source
Well appearing?
Consider other source OR wait for culture with PMD in 24 hours
Discharge criteria
- Reassuring vital signs
- Tolerating PO
- Well-appearing
- No social/family concerns
- Reliable follow up in 24 hours
- Parents comfortable and understand discharge plan
- Provider comfortable with outpatient therapy
Urine bag already placed?
History of UTI?
Contraindications to probiotics?
Probiotics
Meets discharge criteria?
Cephalosporin allergy?
Female?
Cephalexin 25 mg/kg PO 4 times a day x7 days, PMD followup within 24 hours
Cephalosporin allergy?
Infectious disease consult
Consider historical cultures, consider urology or ID consult
Bactrim 6 mg(TMP)/kg PO BID x7 days, PMD followup within 24 hours
Clinical concern for UTI
- Non-toilet trained children
- Fever without a source
- Suprapubic tenderness
- Abdominal pain
- Jaundice
- Frequent unexplained vomiting
- Dysuria, urgency, frequency
- Back pain
Two-step urine collection process (if implemented in the care center)
4 minimal criteria for urine bag to be placed on patient arrival
# | Females | Males | |
1 | Temperature elevation (°C) | ≥38.5 | |
2 | Temperature duration (hours) | ≥48 | |
3 | Age(years) | <2 | Uncircumcised <2 |
Circumcised <1 | |||
4 | History of UTI symptoms concerning for UTI | Any |
Exclusion from urine bag
- < 6 months
- Moderate to severe dehydration
- Potty trained
Presumed UTI on UA?
- Fever > 38.0 C (100.4 F) x1 at home, OSH or in ED
- Clinical concern for UTI
- Toilet trained
- Toxic appearance
- Immunosuppresed, cancer
- Previous GU surgery or anatomical abnormality (VUR, etc.)
- Chronic kidney disease
- Recent history of sexual abuse
- Other pmhx or complicating factor (nephrolitiasis, etc)
Suprapubic tenderness alone OR meets criteria based on risk factors
(2 risk factors for uncircumcised, 3 risk factors for circumcised)
- Nonblack race
- Temperature > 39C
- Fever > 24 hours
- No apparent source
- History of UTI
Urine test Interpretation
Presumed UTI (UA Pyuria)
- Positive nitrite or leukocyte esterase and microscopy showing bacteria or > 10 WBC / hpf
Definitive UTI (Urine culture)
- Urinalysis that suggests infection (pyuria and/or bacteriuria) AND one of the following:
- Suprapubic aspiration: > 1,000 cfus
- Catheter sample: > 50,000 cfus (often reported as 10-50,000 cfus depending on lab)
- Clean catch sample: > 100,000 cfus
Consider other source OR treat empirically for UTI
