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)