Drs Chiang and Shaikh are correct in stating that the urine dipstick or urinalysis does not have perfect sensitivity for detecting all urinary tract infections (UTIs) in young children. As in many cases in medicine, the clinician must weigh the risks and benefits of testing and also rely on good discharge instructions and follow-up.

To account for asymptomatic bacteriuria, the American Academy of Pediatrics guidelines define a UTI as a positive culture in the presence of pyuria. Many are concerned, however, about pyelonephritis in young infants because they may lack signs of inflammation in the urine, perhaps due to the pathogen itself or to diluted urine that does not remain in the bladder for long in young infants. For this reason, we use the 2 stage process beginning at 6 months and do urethral catheterization with culture for all febrile infants <2 months and for those...

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