Clinical outcomes in febrile children with a positive urine culture without pyuria: Implications for antibiotics

Aim

This study aimed to investigate whether antibiotics should be administered to patients aged <2 years with a positive urine culture without pyuria by identifying their clinical characteristics and outcomes in the absence of antibiotic treatment.

Methods

This retrospective, observational study included children aged <2 years with positive findings on a culture of urine obtained using a catheter in the paediatric emergency department between 2016 and 2021. The primary outcome was the spontaneous resolution of fever without antibiotics in patients with a positive urine culture without pyuria. The clinical characteristics of the patients with and without pyuria were also compared.

Results

Of 391 patients, 86 (22%) were negative for pyuria. Of these, 63 (73%) received no antibiotics, and 56 (89%) had spontaneous defervescence and no symptom recurrence. The patients without pyuria had a higher proportion of other possible causes of fever, lower inflammatory markers, fewer cultured bacteria, and a higher proportion of multiple, bacterial species in their culture than the patients with pyuria.

Conclusions

Most of the patients with a positive urine culture without pyuria may not require antibiotics if their fever resolves spontaneously.