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Objective. Previous research has identified clinical predictors for urinary tract infection (UTI) to guide urine screening in febrile children Methods. We conducted a multicenter, prospective, cross-sectional study during consecutive bronchiolitis seasons. All febrile (≥ 38°C) infants who were ≤ 60 days of age and seen at any of 8 pediatric emergency departments from October through March 1999-2001 were eligible. Clinical appearance was evaluated using the Yale Observation Scale. UTI was defined as growth of a known bacterial pathogen from a catheterized specimen at a level of (1) ≥ 50 000 cfu/mL or (2) ≥ 10 000 cfu/mL in association with a positive dipstick test or urinalysis. We used bivariate tests and multiple logistic regression to identify demographic and clinical factors that were associated with the likelihood of UTI. Results. A total of 1025 (67%) of 1513 eligible patients were enrolled; 9.0% of enrolled infants received a diagnosis of UTI. Uncircumcised male infants had a higher rate of UTI (21.3%) compared with female (5.0%) and circumcised male (2.3%) infants. Infants with maximum recorded temperature of ≥ 39°C had a higher rate of UTI (16.3%) than other infants (7.2%). After multivariable adjustment, UTI was associated with being uncircumcised (odds ratio: 10.4; bias-corrected 95% confidence interval: 4.7-31.4) and maximum temperature (odds ratio: 2.4 per °C; 95% confidence interval: 1.5-3.6). Factors that were reported previously to be associated with risk for UTI in infants and toddlers, such as white race and ill appearance, were not significantly associated with risk for UTI in this cohort of young infants. Conclusions. Being uncircumcised and height of fever were associated with UTI in febrile infants who were ≤ 60 days of age. Uncircumcised male infants were at particularly high risk and may warrant a different approach to screening and management. Pediatrics 2005; 116:644-648; fever, infant, urinary tract infection., ABBREVIATIONS. UTI, urinary tract infection; SBI, serious bacterial infection; ED, emergency department; YOS, Yale Observation Scale; RSV, respiratory syncytial virus; cfu, colony-forming units; OR, odds ratio; CI, confidence interval. Urinary [...]

Background. The evaluation of young febrile infants is controversial, in part because it is unclear whether clinical evidence of a viral infection significantly reduces the risk of serious bacterial infections (SBIs). Specifically, it remains unclear whether the risk of SBI is altered in a meaningful way in the presence of respiratory syncytial virus (RSV) infections. Objective. The objective of this study was to determine the risk of SBI in young febrile infants who are infected with RSV compared with those without RSV infections. Methods. We conducted a 3-year multicenter, prospective, cross-sectional study. All febrile ([greater than or equal to] 38[degrees]C) infants who were [less than or equal to] 60 days of age and presented to any of 8 pediatric emergency departments from October through March 1998-2001 were eligible. General clinical appearance was evaluated using the Yale Observational Scale. We determined RSV status by antigen testing of nasopharyngeal secretions. We defined bronchiolitis as either wheezing alone or chest retractions in association with an upper respiratory infection. We evaluated infants with blood, urine, cerebrospinal fluid, and stool cultures. Urinary tract infection (UTI) was defined by single pathogen growth of [greater than or equal to] 5 x [10.sup.4] cfu/mL, or [greater than or equal to] [10.sup.4] cfu/mL in association with a positive urinalysis in a catheterized specimen, or [greater than or equal to] [10.sup.3] cfu/mL in a suprapubic aspirate. Bacteremia, bacterial meningitis, and bacterial enteritis were defined by growth of a known bacterial pathogen. SBI was defined as any of the above-mentioned 4 bacterial infections. Results. We enrolled 1248 patients, including 269 (22%) with RSV infections. The overall SBI status could be determined in 1169 (94%) of the 1248 patients, and the rate of SBIs was 11.4% (133 of 1169; 95% confidence interval [CI]: 9.6%-13.3%). The rate of SBIs in the RSV-positive infants was 7.0% (17 of 244; 95% CI: 4.1%-10.9%) compared with 12.5% (116 of 925; 95% CI: 10.5%-14.8%) in the RSV-negative infants (risk difference: 5.5%; 95% CI: 1.7%-9.4%). The rate of UTI in the RSV-positive infants was 5.4% (14 of 261; 95% CI: 3.0%-8.8%) compared with 10.1% (98 of 966; 95% Ch 8.3%-12.2%) in the RSV-negative infants (risk difference: 4.7%; 95% CI: 1.4%-8.1%). The RSV-positive infants had a lower rate of bacteremia than the RSV-negative infants (1.1% vs 2.3%; risk difference: 1.2%; 95% CI: -0.4% to 2.7%). No RSV-positive infant had bacterial meningitis (0 of 251; 95% CI: 0%-1.2%); however, the differences between the 2 groups with regard to bacteremia and bacterial meningitis did not achieve statistical significance. Conclusions. Febrile infants who are [greater than or equal to] 60 days of age and have RSV infections are at significantly lower risk of SBI than febrile infants without RSV infection. Nevertheless, the rate of SBIs, particularly as a result of UTI, remains appreciable in febrile RSV-positive infants. Pediatrics 2004;113:1728-1734; fever, infant, RSV, serious bacterial infection, bronchiolitis, bacteremia, urinary tract infection., ABBREVIATIONS. SBI, serious bacterial infection; UTI, urinary tract infection; RSV, respiratory syncytial virus; ED, emergency department; CSF, cerebrospinal fluid; UA, urinalysis; CXR, chest radiograph; URI, upper respiratory tract infection; WBC, [...]