Routine Admission of Young Children with Uncomplicated Febrile UTI Is Unnecessary

Most young infants with a febrile urinary tract infection (UTI) are admitted for antibiotic therapy, although this practice is being reconsidered.

In a retrospective review of administrative data from nearly 42,000 pediatric emergency department (ED) visits for uncomplicated febrile UTI in children aged <2 years (mean age, 6.6 months; 69% girls), researchers compared outcomes between patients discharged home on oral antibiotics and hospitalized patients. Admission rates varied between 6% and 64% among the 36 hospitals included. Twenty-seven percent of patients were hospitalized (most were aged <2 months). Lower admission rate was not associated with revisit within 3 days that required hospitalization, although more revisits occurred in the hospitals with the lower admission rates.

In another study, investigators compared estimated costs of discharging versus admitting febrile infants presenting to the ED with UTI. Using published data from 862 infants aged 29–60 days with uncomplicated UTI, they determined the probability of bacteremia to be 3.2% and the adverse event risk to be 0%. Costs were estimated from U.S. hospital data. The cost per patient for admission was US$9,394 with bacteremia and $2,978 without bacteremia. The cost for discharging a patient home initially (and later admitting if bacteremic) was $9,695 with bacteremia and $312 without bacteremia. The cost savings associated with home management of infants with UTI was $257,000 per 100 patients. Ninety percent of admission costs, charges, and reimbursements were the result of admitting low-risk patients who were never bacteremic.