In a young child with fever and dysuria, how should a UTI be evaluated?

• A. Obtain a urine sample via catheterization for urinalysis and culture; treat with appropriate antibiotics.
• B. Rely on symptoms and treat empirically.
• C. Obtain a urine bag specimen for culture only.
• D. Do not test and observe.

Answer: (A)

When a young child has fever with dysuria, you can’t rely on symptoms alone to diagnose a UTI. The key is obtaining a reliable urine sample for both urinalysis and culture, so you can confirm infection and identify the responsible organism and its antibiotic sensitivities.

In infants and small children, the cleanest way to get a reliable sample is catheterization (or suprapubic aspiration if catheterization isn’t possible). This minimizes contamination that can occur with bag specimens. A urine bag specimen is easy but highly prone to contamination, which makes culture results unreliable and can lead to inappropriate treatment. Not testing or treating empirically without objective confirmation risks missing a tricky infection or giving the wrong antibiotic. Therefore, obtaining a catheterized urine sample for urinalysis and culture, followed by targeted antibiotic therapy, is the best approach.