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Indications for urinalysis and urine culture in febrile children age ≥1

month with suspected UTI and no abnormalities of the urinary tract [1,2]

Age, sex, and circumcision status Indications for urine sample

1 to <2 months

Females and males (circumcised or Fever ≥38°C

uncircumcised)

2 through 11 months

Females and uncircumcised males Fever ≥38°C

Circumcised males Fever ≥38°C and any of the following

combinations:
No other source of fever* and history
of UTI ¶
No other source of fever*, maximum
fever ≥39°C, and fever ≥48 hours
Other source of fever*, history of UTI ¶ ,
maximum fever ≥39°C, and fever ≥48
hours

12 through 23 months

Females and uncircumcised males Any of the following combinations:

Fever ≥38°C and history of UTI ¶ Δ
Fever ≥38°C and no other source of
fever*
Maximum fever ≥39°C and fever ≥48
hours

Circumcised males The combination of no other source of

fever*, maximum fever ≥39°C, history of
UTI ¶ , and fever ≥48 hours

≥24 months

Females and uncircumcised males: ≥1 Clinical findings:

 clinical finding Dysuria
Circumcised males: ≥2 clinical findings Frequency
New-onset incontinence
Abdominal pain
Back pain
Fever ≥39°C if no other source of fever
is identified*

This table is meant for use with UpToDate content on UTI in children. The indications for
obtaining urine samples correspond to a pretest probability of UTI ≥2% (ie, approximately 10
children need to be tested for every UTI detected, which are the thresholds used in UTICalc,
available from the University of Pittsburgh). [1] Thresholds may vary depending on duration of
symptoms, feasibility of follow-up, and parental views toward catheterization.

UTI: urinary tract infection.

* Other source of fever includes (but is not limited to) acute otitis media; pneumonia;
meningitis; upper respiratory tract infection, gastroenteritis, bronchiolitis, or other viral
syndrome.
¶ Documented UTI or UTI reported by caregiver.
Δ Although the pretest probability is <2% for female or uncircumcised children age 12 through
23 months with a history of UTI, maximum temperature <39°C, and fever <48 hours, children
with a history of febrile UTI are at increased risk for renal scarring with recurrent UTI and we
obtain a urine sample for urinalysis and urine culture in such children.

References:
1. University of Pittsburgh. UTICalc version 3.0. Available at: https://uticalc.pitt.edu/ (Accessed on July 28, 2021).
2. Shaikh N, Hoberman A, Hum SW, et al. Development and validation of a calculator for estimating the
probability of urinary tract infection in young febrile children. JAMA Pediatr 2018; 172:550.

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