Racial and ethnic differences in the rates of urinary tract infections in febrile infants in the emergency department

OBJECTIVE: To characterize the racial and ethnic differences in rates of urinary tract infections among febrile infants who present to an urban pediatric emergency department. METHODS: A retrospective chart review was conducted using the medical records of an urban pediatric emergency department from the period between 5/2002 and 1/2003. Data were collected from infants aged 1 to 24 months from whom urine cultures were obtained as part of their fever workup. Demographic data were recorded as provided by the parents or caregivers of the patients. Urine culture results were also recorded. RESULTS: Four hundred and sixty five children had urine cultures performed during the study period and fulfilled the inclusion criteria. Parents characterized the children as white (45%), Hispanic (27%), African American (20%), Asian (3.9%), or others (4.3%). Clinical parameters including the height of fever, age of the patient, and proportion of men were similar between the subjects in each racial and ethnic group. Sixty-four children were diagnosed as having UTI. The overall prevalence of UTI was 14% (95% confidence interval [CI] 11%-17%). Rates of UTI (SD) were as follows: Asian 22% (10%), white 16% (2.4%), Hispanic 16% (3.1%), African American 4.0% (1.9%), and Others 11 % (6.2%). African American infants had a lower rate of UTI (p = 0.007) compared with the general population. The odds ratio (OR) of UTI in hite versus African American children and Hispanic versus African American children were 4.4 (95% CI, 1.5 to 12.6) and 4.6 (95% CI, 1.5 to 13.9), respectively. These results were consistent after adjustment for sex. CONCLUSIONS: Urinary tract infections were common in our study population of racially and ethnically diverse children. Given similar clinical parameters, white and Hispanic children were much more likely to be diagnosed with UTI than African-American children.