ANC: absolute neutrophil count; CBC: complete blood count; CRP: C-reactive protein; CSF: cerebrospinal fluid; IM: blood inflammatory marker; IBI: invasive bacterial illness; LP: lumbar puncture; PCT: procalcitonin; PECARN: Pediatric Emergency Care Applied Research Network.
* Obtain urine sample by bladder catheterization or suprapubic aspiration. It is reasonable for clinicians to also send a urine culture with initial urine testing in settings with documented low rates of specimen contamination and with timely specimen processing. Urine specimens obtained using bag collection are not acceptable for culture.
¶ Abnormal urine testing includes any one of the following:
Δ Oral antibiotics according to regional susceptibility of E. coli; it is reasonable to give a parenteral dose (intravenous or intramuscular) of ceftriaxone in the emergency department as a first dose. Refer to UpToDate content on management of urinary tract infections in infants >1 month old and children.
◊ If the social situation suggests that follow-up within 24 hours is problematic (eg, unreliable transportation, no phone, parent/primary caregiver inability to assess severity of illness, or other concerns regarding parental adherence), then admit the infant.