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Am Fam Physician. 2004;69(7):1738-1743

Clinical Question: How useful are follow-up urine cultures in children hospitalized with urinary tract infections (UTIs) and fever?

Setting: Inpatient (any location) with outpatient follow-up

Study Design: Cohort (prospective)

Synopsis: The authors of this study retrospectively reviewed the records of 364 children younger than 18 years who were discharged from the hospital with a diagnosis of UTI or pyelonephritis. UTI was defined as more than 10,000 colony-forming units (CFU) per mL by a catheter specimen or more than 100,000 CFU per mL by the clean-catch method. One third of the children had a fever that persisted at 48 hours after admission. The American Academy of Pediatrics recommends doing a follow-up culture in 48 hours in the absence of expected clinical response. Approximately 80 percent of the admitted children had a follow-up culture within 72 hours of admission to the hospital. None of the cultures was positive, resulting in no change in management or outcome.

Bottom Line: In this study of children admitted to the hospital with fever and a UTI, follow-up urine cultures were universally negative, providing no guidance for managing persistent fever. (Level of Evidence: 1c)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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Copyright © 2004 by the American Academy of Family Physicians.

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