PMID- 26009628
OWN - NLM
STAT- MEDLINE
DCOM- 20150820
LR  - 20151223
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Linking)
VI  - 135
IP  - 6
DP  - 2015 Jun
TI  - Diagnostic accuracy of the urinalysis for urinary tract infection in infants <3
      months of age.
PG  - 965-71
LID - 10.1542/peds.2015-0012 [doi]
AB  - BACKGROUND: The 2011 American Academy of Pediatrics urinary tract infection (UTI)
      guideline suggests incorporation of a positive urinalysis (UA) into the
      definition of UTI. However, concerns linger over UA sensitivity in young infants.
      Infants with the same pathogenic organism in the blood and urine (bacteremic UTI)
      have true infections and represent a desirable population for examination of UA
      sensitivity. METHODS: We collected UA results on a cross-sectional sample of 276 
      infants <3 months of age with bacteremic UTI from 11 hospital systems.
      Sensitivity was calculated on infants who had at least a partial UA performed and
      had >/=50 000 colony-forming units per milliliter from the urine culture.
      Specificity was determined by using a random sample of infants from the central
      study site with negative urine cultures. RESULTS: The final sample included 245
      infants with bacteremic UTI and 115 infants with negative urine cultures. The
      sensitivity of leukocyte esterase was 97.6% (95% confidence interval [CI]
      94.5%-99.2%) and of pyuria (>3 white blood cells/high-power field) was 96% (95%
      CI 92.5%-98.1%). Only 1 infant with bacteremic UTI (Group B Streptococcus) and a 
      complete UA had an entirely negative UA. In infants with negative urine cultures,
      leukocyte esterase specificity was 93.9% (95% CI 87.9 - 97.5) and of pyuria was
      91.3% (84.6%-95.6%). CONCLUSIONS: In young infants with bacteremic UTI, UA
      sensitivity is higher than previous reports in infants with UTI in general. This 
      finding can be explained by spectrum bias or by inclusion of faulty gold
      standards (contaminants or asymptomatic bacteriuria) in previous studies.
CI  - Copyright (c) 2015 by the American Academy of Pediatrics.
FAU - Schroeder, Alan R
AU  - Schroeder AR
AD  - Department of Pediatrics, Santa Clara Valley Medical Center, San Jose,
      California; Alan.Schroeder@hhs.sccgov.org.
FAU - Chang, Pearl W
AU  - Chang PW
AD  - Department of Pediatrics, Kaiser Permanente Northern California, Oakland,
      California;
FAU - Shen, Mark W
AU  - Shen MW
AD  - Department of Pediatrics, Dell Children's Medical Center, Austin, Texas; and.
FAU - Biondi, Eric A
AU  - Biondi EA
AD  - Department of Pediatrics, University of Rochester, Rochester, New York.
FAU - Greenhow, Tara L
AU  - Greenhow TL
AD  - Department of Pediatrics, Kaiser Permanente Northern California, Oakland,
      California;
LA  - eng
PT  - Evaluation Studies
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
SB  - AIM
SB  - IM
CIN - Pediatrics. 2015 Jun;135(6):1126-7. PMID: 26009629
CIN - Pediatrics. 2015 Oct;136(4):e1167-8. PMID: 26430144
CIN - Pediatrics. 2015 Oct;136(4):e1167. PMID: 26430143
MH  - Bacteremia/complications/urine
MH  - Cross-Sectional Studies
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Sensitivity and Specificity
MH  - Urinalysis
MH  - Urinary Tract Infections/complications/*diagnosis/*urine
EDAT- 2015/05/27 06:00
MHDA- 2015/08/21 06:00
CRDT- 2015/05/27 06:00
PHST- 2015/05/27 06:00 [entrez]
PHST- 2015/05/27 06:00 [pubmed]
PHST- 2015/08/21 06:00 [medline]
AID - peds.2015-0012 [pii]
AID - 10.1542/peds.2015-0012 [doi]
PST - ppublish
SO  - Pediatrics. 2015 Jun;135(6):965-71. doi: 10.1542/peds.2015-0012.