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JAMA Pediatr. 2019 Jan 28. doi: 10.1001/jamapediatrics.2018.5091. [Epub ahead of print]

Association of Diagnostic Criteria With Urinary Tract Infection Prevalence in Bronchiolitis: A Systematic Review and Meta-analysis.

Author information

Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle.
Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
The Dartmouth Institute for Health Policy and Clinical Practice and the Department of Medicine, Lebanon, New Hampshire.
Department of Pediatrics, Stanford University School of Medicine, Stanford, California.



Concomitant urinary tract infection (UTI) is a frequent concern in febrile infants with bronchiolitis, with a prior meta-analysis suggesting a prevalence of 3.3%. However, the definition of UTI in these studies has generally not incorporated urinalysis (UA) results.


To conduct a systematic review and meta-analysis examining the prevalence of UTI in infants with bronchiolitis when positive UA results are incorporated into the UTI definition.

Data Sources:

Medline (1946-2017) and Ovid EMBASE (1976-2017) through August 2017 and bibliographies of retrieved articles.

Study Selection:

Studies reporting UTI prevalence in bronchiolitis.

Data Extraction:

Data were extracted in accordance with meta-analysis of observational studies in epidemiology guidelines via independent abstraction by multiple investigators. Random-effects models generated a weighted pooled event rate with corresponding 95% confidence intervals.

Main Outcomes and Measures:

Prevalence of UTI.


We screened 477 unique articles by abstract, with full-text review of 30 studies. Eighteen bronchiolitis studies reported a UTI prevalence and 7 of these reported UA data for inclusion in the meta-analysis. The overall reported prevalence of UTI in bronchiolitis from these 18 studies was 3.1% (95% CI, 1.8%-4.6%). With the addition of positive UA results (defined as the presence of pyuria or nitrites) as a diagnostic criterion, the prevalence of UTI as reported in the 7 studies in bronchiolitis was 0.8% (95% CI, 0.3%-1.4%). Sensitivity analyses yielded similar results, including for infants younger than 90 days. Heterogeneous definitions of UTI and UA criteria introduced uncertainty into prevalence estimates.

Conclusions and Relevance:

When a positive UA result is added as a diagnostic criterion, the estimated prevalence of concomitant UTI is less than recommended testing thresholds for bronchiolitis.

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