PMID- 27940788
OWN - NLM
STAT- MEDLINE
DCOM- 20170626
LR  - 20181002
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Linking)
VI  - 138
IP  - 5
DP  - 2016 Nov
TI  - Urine Concentration and Pyuria for Identifying UTI in Infants.
LID - e20162370 [pii]
AB  - BACKGROUND: Varying urine white blood cell (WBC) thresholds have been recommended
      for the presumptive diagnosis of urinary tract infection (UTI) among young
      infants. These thresholds have not been studied with newer automated urinalysis
      systems that analyze uncentrifuged urine that might be influenced by urine
      concentration. Our objective was to determine the optimal urine WBC threshold for
      UTI in young infants by using an automated urinalysis system, stratified by urine
      concentration. METHODS: Retrospective cross-sectional study of infants aged <3
      months evaluated for UTI in the emergency department with paired urinalysis and
      urine culture. UTI was defined as >/=50 000 colony-forming units/mL from
      catheterized specimens. Test characteristics were calculated across a range of
      WBC and leukocyte esterase (LE) cut-points, dichotomized into specific gravity
      groups (dilute <1.015; concentrated >/=1.015). RESULTS: Twenty-seven thousand
      infants with a median age of 1.7 months were studied. UTI prevalence was 7.8%.
      Optimal WBC cut-points were 3 WBC/high-power field (HPF) in dilute urine
      (likelihood ratio positive [LR+] 9.9, likelihood ratio negative [LR] 0.15) and 6 
      WBC/HPF (LR+ 10.1, LR 0.17) in concentrated urine. For dipstick analysis,
      positive LE has excellent test characteristics regardless of urine concentration 
      (LR+ 22.1, LR 0.12 in dilute urine; LR+ 31.6, LR 0.22 in concentrated urine).
      CONCLUSIONS: Urine concentration should be incorporated into the interpretation
      of automated microscopic urinalysis in young infants. Pyuria thresholds of 3
      WBC/HPF in dilute urine and 6 WBC/HPF in concentrated urine are recommended for
      the presumptive diagnosis of UTI. Without correction of specific gravity,
      positive LE by automated dipstick is a reliably strong indicator of UTI.
CI  - Copyright (c) 2016 by the American Academy of Pediatrics.
FAU - Chaudhari, Pradip P
AU  - Chaudhari PP
AD  - Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical
      School, Boston, Massachusetts pradip.chaudhari@childrens.harvard.edu.
FAU - Monuteaux, Michael C
AU  - Monuteaux MC
AD  - Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical
      School, Boston, Massachusetts.
FAU - Bachur, Richard G
AU  - Bachur RG
AD  - Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical
      School, Boston, Massachusetts.
LA  - eng
PT  - Journal Article
DEP - 20161018
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
SB  - AIM
SB  - IM
CIN - Pediatrics. 2016 Nov;138(5):. PMID: 27940802
CIN - Evid Based Med. 2017 Jun;22(3):115. PMID: 28526711
MH  - Academic Medical Centers
MH  - Area Under Curve
MH  - Automation
MH  - Confidence Intervals
MH  - Cross-Sectional Studies
MH  - Female
MH  - Hospitals, Pediatric
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Leukocyte Count
MH  - Leukocytes
MH  - Male
MH  - Predictive Value of Tests
MH  - Pyuria/*diagnosis/epidemiology/therapy
MH  - ROC Curve
MH  - Retrospective Studies
MH  - Urinalysis/*methods
MH  - Urinary Tract Infections/*diagnosis/epidemiology/therapy
EDAT- 2016/12/13 06:00
MHDA- 2017/06/27 06:00
CRDT- 2016/12/13 06:00
PHST- 2016/08/09 00:00 [accepted]
PHST- 2016/12/13 06:00 [entrez]
PHST- 2016/12/13 06:00 [pubmed]
PHST- 2017/06/27 06:00 [medline]
AID - peds.2016-2370 [pii]
AID - 10.1542/peds.2016-2370 [doi]
PST - ppublish
SO  - Pediatrics. 2016 Nov;138(5). pii: peds.2016-2370. doi: 10.1542/peds.2016-2370.
      Epub 2016 Oct 18.