When more than one recommended option exists for a low-risk infant, providers should engage in shared decision-making, reflecting both provider and caregiver goals of care and risk tolerance. 14, 15
See Treatment section below for choice and dosing of empiric antimicrobials.

Low-risk infants are admitted; there are 2 options for management:
1. Option 1 – Admit for observation without LP or empiric antimicrobials.
2. Option 2 – Perform LP and admit infants with a normal CSF WBC count, with or without empiric antimicrobials.
Any positive blood or urine culture should prompt LP for CSF testing (if not already performed) and initiation of empiric antimicrobials.
High-risk infants should have LP for CSF testing, empiric antimicrobials and be admitted for close observation pending culture results.

Low-risk infants may be discharged; there are 2 options for management:
1. Option 1 – Discharge home and arrange follow-up within 24-48 hours. Provide caregivers with anticipatory guidance on when to return to the Emergency Department (ED). Ensure appropriate follow-up of culture results.
2. Option 2 – Admit for observation with no LP or empiric antimicrobials until all cultures are negative for 24 hours.
Infants 29-60 days old with a suspected ISOLATED UTI (e.g., urine positive for leukocyte esterase, nitrites or >5 WBC/hpf AND otherwise meeting the remainder of low-risk criteria; see Table 1) DO NOT require LP. Treat empirically with PO or IV antibiotics (10-14 days). Use shared decision-making to decide on admission versus discharge home.
Any positive blood culture should prompt LP for CSF testing (if not already performed) and initiation of empiric antimicrobials.
High-risk infants should have LP for CSF testing, empiric antimicrobials, and be admitted for close observation pending culture results.