P2.154: Gross Hematuria and Urinary Tract Infections Among Young Male Patients in the Emergency Department (ED)

Background: Hemorrhagic urinary tract infections (UTIs) are rare among healthy young males and lack epidemiologic data as well as a standardized clinical approach in the ED. The spectrum of pathogens behind hemorrhagic UTIs is also poorly characterized. The purpose of this study is to investigate the clinical presentation and lab features of UTIs in healthy young males presenting to the ED with gross hematuria.

Methods: We conducted a retrospective chart review of male patients aged 1–8 years presenting to a single urban pediatric ED between January 2018 and December 2023 with ICD-10 codes related to hematuria, UTI, dysuria, balanitis, and other genitourinary complaints. Inclusion criteria were urinary symptoms including gross hematuria during the ED visit. Patients were excluded if they had pre-existing urologic, oncologic, hematologic, immunodeficiency, or trauma diagnoses. Demographic, clinical, laboratory, and imaging data were extracted. UTI was defined per American Academy of Pediatrics guidelines as pyuria with ≥100,000 CFU/mL for clean-catch specimens or ≥10,000 CFU/mL for catheterized specimens. Gross hematuria was defined as a symptom of visible blood in the patient’s urine and/or > 50 red blood cells per high powered field on urinalysis.

Results: From an interim total of 456 male pediatric patients who met initial inclusion criteria, 209 were excluded due to a significant urology (56%), hematology/oncology (9%), immunodeficiency (4%), acute trauma (5%), and/or other (26%) diagnosis. Of those patients who remained, 45% had a documented circumcision status, with 83% uncircumcised and 17% circumcised. Dysuria (46%), fever (34%), and hematuria (27%) were the most common presenting symptoms. Urology (1.5%) and Nephrology (1.5%) consults in the ED were rare, with most patients discharged home (91%). UTI (30%), fever (15%), balanitis/balanoposthitis (12%), and unspecified hematuria (10%) were among the most significant ED diagnoses. After recategorizing by urinalysis-defined hematuria and/or positive symptoms, 30% of patients had defined gross hematuria, whereas 70% did not. Gross hematuria was associated with older age (median 5.1 vs 3.2 years, p< 0.001) and a lower proportion of confirmed UTI (10% vs 24%, p=0.009). After adjusting for confounders, gross hematuria was associated with a reduced risk of UTI (OR 0.35 (CI 0.15-0.85), p=0.02). No significant differences in urologic complications, ED antibiotic administration, or 6-month outcomes were observed between patients with and without gross hematuria. E. coli (12%) was the most commonly isolated organism - alongside Klebsiella, Enterococcus, Staphylococcus epidermidis, and Proteus mirabilis.

Conclusion: Our study shows that gross hematuria at the time of ED presentation was not a reliable predictor of confirmed UTI in this pediatric male cohort. Our findings suggest that isolated gross hematuria should not prompt antibiotic treatment in the absence of other supportive clinical or laboratory findings. Ongoing analysis will provide additional insight and power to our results, which may help inform clinical decision-making.