Urinary tract infection is the commonest serious bacterial infection in children under three with fever and no focus. In the European trial reported below, 15.7% of such children had a serious bacterial infection.
A clean urine sample, by catheter or suprapubic aspiration in young infants, or a clean-catch in older ones, is the single most useful test. Bag specimens are acceptable to rule out infection only when negative.
- Obtain urine in every child under 3 with fever and no source.
- Use a catheter or clean-catch sample for culture; a bag sample is only useful if negative.
- Infants under 3 months with fever need a full assessment regardless of how well they look.
- Send urine for culture before giving antibiotics, but do not delay antibiotics for a sample in a seriously unwell child.
Why it matters
The commonest serious infection in these children is also the one most easily missed without a sample.
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