Neonatology
Infectious Diseases
Hospital-based Medicine
General Pediatrics
Emergency Medicine
Marie Wang, MD, MPH
Clinical Associate Professor
Pediatrics
Stanford University
Sunnyvale, California, United States
Urinary tract infection (UTI) is one of the most common bacterial infections in infants, and occurs in up to 10% of febrile infants <2 months old. Young febrile infants with UTI are commonly encountered in outpatient and inpatient settings and across specialties such as general pediatrics, emergency medicine, hospital medicine, neonatology, and infectious diseases. Current AAP UTI Guidelines address diagnosis and management for 2-24 month olds but do not provide guidance for infants younger than 2 months of age. Consequently, there is uncertainty and variability in diagnosis and management of UTI in the <2 month age group. This session will use case vignettes to provide an engaging review of the latest evidence and multidisciplinary discussion of the following topics: 1) Different definitions of UTI and the role of colony count, urinalysis results and collection method, 2) Routine vs. targeted lumbar puncture in infants with a positive urinalysis, 3) Duration of parenteral therapy for UTI with and without bacteremia, and 4) Imaging following first febrile UTI.
A panel of experts on urinary tract infection in febrile young infants representing diverse fields (general pediatrics, hospital medicine, emergency medicine, and infectious diseases) will discuss these topics in a moderated format. The session will begin with a brief review of the AAP UTI Guidelines and reasons for special considerations in the <2 month age group. Each topic will begin with a case vignette with audience response polling to assess current practice related to that topic. A focused review of relevant pediatric literature will be provided, followed by a moderated panel discussion to discuss various perspectives. There will be 19 minutes allotted for each topic (12 min presentation followed by 7 minutes of discussion and audience question-and-answer session). Audience members will be able to submit questions through the PAS virtual presentation platform. The moderator will select from the audience questions and facilitate the question-and-answer session per topic, allowing for a total of 28 minutes of attendee-driven discussion to promote in-depth conversations about current controversies. The session will conclude with an overview of future directions for research. Attendees will gain a strong evidence base from which to manage UTI in the <2 month population.
Outline:
1. Overview of AAP UTI Guidelines and Special Considerations for <2 month old infants (10 min)
2. Defining a “Gold Standard” for UTI Diagnosis: Role of the Urinalysis, Urine Culture, and Method of Collection (19 min)
3. Routine vs. Selective Lumbar Puncture in Infants with a Positive Urinalysis (19 min)
4. Duration of Parenteral Antibiotic Therapy and Outcomes (19 min)
5. Routine Imaging Following First Febrile UTI (19 min)
6. Future Directions (4 min)
Presenter: Marie Wang, MD, MPH – Stanford University
Presenter: Thomas Newman, MD MPH – UCSF
Presenter: Paul Aronson, MD, MHS – Yale School of Medicine
Presenter: Alan Schroeder, MD – Stanford
Presenter: Pearl Chang, MD – Seattle Children's Hospital / University of Washington