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Pediatrics. 2018 Feb;141(2). pii: e20173068. doi: 10.1542/peds.2017-3068. Epub 2018 Jan 16.

Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger.

Author information

1
Departments of Emergency Medicine and lstzimenatos@ucdavis.edu.
2
Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
3
Division of Emergency Medicine, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York.
4
Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
5
Section of Pediatric Emergency Medicine, Department of Emergency Medicine, Hasbro Children's Hospital and Brown University, Providence, Rhode Island.
6
Department of Pediatrics, Jacobi Medical Center and Albert Einstein College of Medicine, New York, New York.
7
Department of Emergency Medicine, Hurley Medical Center and University of Michigan, Flint, Michigan.
8
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
9
Department of Pediatrics, University of Utah, Salt Lake City, Utah; and.
10
Division of Pediatric Infectious Diseases and Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio.
11
Departments of Emergency Medicine and.
12
Pediatrics, University of California, Davis School of Medicine, Sacramento, California.

Abstract

OBJECTIVES:

Reports of the test accuracy of the urinalysis for diagnosing urinary tract infections (UTIs) in young febrile infants have been variable. We evaluated the test characteristics of the urinalysis for diagnosing UTIs, with and without associated bacteremia, in young febrile infants.

METHODS:

We performed a planned secondary analysis of data from a prospective study of febrile infants ≤60 days old at 26 emergency departments in the Pediatric Emergency Care Applied Research Network. We evaluated the test characteristics of the urinalysis for diagnosing UTIs, with and without associated bacteremia, by using 2 definitions of UTI: growth of ≥50 000 or ≥10 000 colony-forming units (CFUs) per mL of a uropathogen. We defined a positive urinalysis by the presence of any leukocyte esterase, nitrite, or pyuria (>5 white blood cells per high-power field).

RESULTS:

Of 4147 infants analyzed, 289 (7.0%) had UTIs with colony counts ≥50 000 CFUs/mL, including 27 (9.3%) with bacteremia. For these UTIs, a positive urinalysis exhibited sensitivities of 0.94 (95% confidence interval [CI]: 0.91-0.97), regardless of bacteremia; 1.00 (95% CI: 0.87-1.00) with bacteremia; and 0.94 (95% CI: 0.90-0.96) without bacteremia. Specificity was 0.91 (95% CI: 0.90-0.91) in all groups. For UTIs with colony counts ≥10 000 CFUs/mL, the sensitivity of the urinalysis was 0.87 (95% CI: 0.83-0.90), and specificity was 0.91 (95% CI: 0.90-0.92).

CONCLUSIONS:

The urinalysis is highly sensitive and specific for diagnosing UTIs, especially with ≥50 000 CFUs/mL, in febrile infants ≤60 days old, and particularly for UTIs with associated bacteremia.

PMID:
29339564
PMCID:
PMC5810602
DOI:
10.1542/peds.2017-3068
[Indexed for MEDLINE]
Free PMC Article

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