Boys under 6 months presenting with their first febrile urinary tract infection

Abstract

BACKGROUND AND INTRODUCTION: Urinary tract infections are common in children and can cause morbidity. International and local guidelines differ in their recommendations for the investigation of infants following a first febrile UTI, especially for those under 6 months of age. In particular, most medical guidelines do not offer any recommendation for early surgical referral. We looked at a cohort of boys less than 6 months of age presenting with their first UTI and sought to determine whether any features in the investigation paradigm should alert a paediatrician to consider early referral to paediatric surgery.

METHOD: We performed a retrospective analysis of all boys less than 6 months of age presenting with their first febrile UTI to the emergency department of Mater Dei Hospital in the period between January 2020 to December 2021.

RESULTS: 38 boys were included. All underwent a renal US: 13 (34%) had an abnormal US. An MCUG was abnormal in 72.7% of boys with an abnormal US vs 32% of those with a normal US, but this was not statistically significant. DMSA was more likely to be abnormal in those with an abnormal US and abnormal MCUG; all boys with a normal US and normal MCUG had a normal DMSA scan. Twelve boys underwent cystoscopy: 11 had abnormal findings. Only 1 boy had previous normal US and MCUG; all the rest had an abnormal MCUG with/without an abnormal US. 9 boys with positive findings on cystoscopy were aged 2 months or less with a median age of 7 weeks at presentation.

CONCLUSION: For this cohort we determined that one should proceed to an MCUG even if the US findings are normal; a DMSA scan is not helpful in deciding whether to proceed to cystoscopy; the ‘top-down’ approach for investigation should not be advocated for boys less than 2 months of age; boys with first febrile UTI aged 2 months or less should be referred for consideration of cystoscopy.