Clinical Fellow Tokyo Metropolitan Children's Medical Center Fuchu, Tokyo, Japan
Background: The diagnosis of febrile urinary tract infection (UTI) in infants is challenging because of its nonspecific presentation. The presence of respiratory symptoms in some of these infants further complicates the problem, as the presence of other causes of fever is thought to decrease the risk of UTI. Febrile UTI infants with respiratory symptoms may be susceptible to diagnostic delay compared with those without. Objective: To evaluate whether antibiotic treatment of febrile urinary tract infection (UTI) is delayed in febrile infants with respiratory symptoms compared with those without. Design/Methods: Data of infants aged 2 to 24 months diagnosed with UTI from March 1, 2012 to May 31, 2023 were collected from our hospital's medical charts and triage records. Patients with known congenital anomalies of the kidney and urinary tract or a history of febrile UTI were excluded. Patients were classified as having respiratory symptoms if they had any of the following symptoms or clinical signs: cough, rhinorrhea, pharyngeal hyperemia, and otitis media. Time to first antibiotic treatment from fever onset was compared between patients with and without respiratory symptoms. A Cox regression model was constructed to adjust for potential confounders. Results: A total of 214 patients were eligible for analysis. The median age of the eligible patients was 5.0 months (IQR 3.0-8.8) and 118 (55%) were male. There were 104 and 110 patients in the respiratory symptoms and no respiratory symptoms groups, respectively. The time to first antibiotic treatment was significantly longer in the group with respiratory symptoms (51 hours vs. 21 hours). Respiratory symptoms were significantly associated with a longer time to first treatment after adjustment for age and sex in the Cox regression model (hazard ratio [HR] = -0.41, 95% CI: -0.76 to -0.18).
Conclusion(s): Treatment of febrile UTI infants with respiratory symptoms tends to be delayed. Pediatricians should not exclude febrile UTI even in the presence of respiratory symptoms.
