Bottom line: The 2011 UTI guidelines provide good advice on diagnosing UTIs.
1. We have more data that evidence of inflammation is essential for diagnosing gram-negative UTIs.
2. We also have more evidence that 50,000 CFU/mL is a good threshold for diagnosing UTIs.
3. It appears that microscopic bacteriuria did not add significantly to the either sensitivity or specificity.
4. And we now have more evidence that these criteria also apply to infants < 2 months of age.
To close the loop on our case, the child’s CSF and blood cultures were negative, but the urine culture revealed > 100,000 CFU/mL of E. coli susceptible to second- and third-generation cephalosporins, ciprofloxacin, and nitrofurantoin, but resistant to trimethoprim-sulfamethoxazole.
Have a great summer and watch for UTIs in your young patients < 90 days old and fever without apparent focus.
Dr. Harrison is professor of pediatrics and pediatric infectious diseases at Children’s Mercy Hospitals and Clinics, Kansas City, Mo. He said he had no relevant financial disclosures. E-mail Dr. Harrison at pdnews@frontlinemedcom.com.