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Definition of urinary tract infection in children

Definition of urinary tract infection in children
Diagnostic criteria Definition (any of the following)
Significant bacteriuria
  • ≥100,000 CFU/mL of a single uropathogen from a clean-catch specimen
  • ≥10,000 CFU/mL of a single uropathogen from a catheterized specimen
  • ≥1000 CFU/mL of uropathogenic bacteria from a suprapubic aspirate
Clinically relevant uropathogen*
  • Escherichia coli
  • Klebsiella spp
  • Proteus spp
  • Enterobacter spp
  • Citrobacter spp
  • Serratia marcescens
  • Staphylococcus saprophyticus
  • Enterococcus spp
  • Streptococcus agalactiae
  • Pseudomonas aeruginosa
Symptomatic patient Symptoms in infants and young children:
  • Fever
  • Irritability
Symptoms in older children:
  • Dysuria
  • Frequency
  • New-onset incontinence
  • Abdominal pain
  • Back pain
  • Fever
Pyuria (usually present)
  • Positive leukocyte esterase (≥trace) on dipstick analysis
  • ≥5 WBC/high-power field on standardized microscopy
  • ≥10 WBC/mm3 on a hemocytometer
  • Pyuria according to automated microscopy
This table is meant for use with the UpToDate topic on UTI in infants and children older than 1 month. Refer the UpToDate topic for additional details, including indications for obtaining urine samples for dipstick analysis, microscopic analysis, and urine culture.

UTI: urinary tract infection; CFU: colony forming units; WBC: white blood cells.

* Lactobacillus spp, coagulase-negative staphylococci, and Corynebacterium spp are not clinically relevant uropathogens.

¶ UTI may be diagnosed in the absence of pyuria in children with symptoms of UTI. Lack of pyuria is particularly prevalent when the uropathogen isolated is Enterococcus spp, Klebsiella spp, or P. aeruginosa. However, given the high proportion of UTI caused by E. coli, most cases of bacteriuria without pyuria are observed in children with E. coli. We provide antimicrobial therapy for these symptomatic children despite the lack of pyuria.
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