Urinary infection is the commonest serious bacterial infection in febrile infants without a source. Test the urine in any infant under three months with fever, and in older infants and young children with unexplained fever.
The sample matters. A bag specimen can rule infection out if negative but has a high false-positive rate; a positive bag result needs confirming with a catheter, suprapubic or clean-catch sample before treatment where possible. Send a culture before the first antibiotic dose.
An infant who is unwell should not wait for a perfect sample — treat, but get the best sample you can first.
- Test urine in febrile infants without an obvious source
- Use catheter, suprapubic or clean-catch samples for diagnosis
- Do not diagnose UTI on a positive bag specimen alone
- Send culture before the first antibiotic dose
Why it matters
Bag specimens drive false diagnoses, unnecessary imaging and prophylaxis.
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