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Observational Study
. 2018 Feb;141(2):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

Leah Tzimenatos  1 , Prashant Mahajan  2 , Peter S Dayan  3 , Melissa Vitale  4 , James G Linakis  5 , Stephen Blumberg  6 , Dominic Borgialli  7 , Richard M Ruddy  8 , John Van Buren  9 , Octavio Ramilo  10 , Nathan Kuppermann  11   12 ; Pediatric Emergency Care Applied Research Network (PECARN)
Affiliations
Observational Study

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

Leah Tzimenatos et al. Pediatrics. 2018 Feb.

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.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Ramilo has received research grants from Janssen. Dr Ramilo has received fees for participation in advisory boards from Abbvie, Janssen, and Regeneron and for lectures from Abbvie, Pfizer, and Johnson & Johnson, all of which are unrelated to the current study; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Patient flow diagram.
See this image and copyright information in PMC

Comment in

References

    1. Byington CL, Reynolds CC, Korgenski K, et al. . Costs and infant outcomes after implementation of a care process model for febrile infants. Pediatrics. 2012;130(1). Available at: www.pediatrics.org/cgi/content/full/130/1/e16 - PMC - PubMed
    1. Greenhow TL, Hung YY, Herz AM, Losada E, Pantell RH. The changing epidemiology of serious bacterial infections in young infants. Pediatr Infect Dis J. 2014;33(6):595–599 - PubMed
    1. Gomez B, Mintegi S, Bressan S, Da Dalt L, Gervaix A, Lacroix L; European Group for Validation of the Step-by-Step Approach . Validation of the “step-by-step” approach in the management of young febrile infants. Pediatrics. 2016;138(2):e20154381. - PubMed
    1. Glissmeyer EW, Korgenski EK, Wilkes J, et al. . Dipstick screening for urinary tract infection in febrile infants. Pediatrics. 2014;133(5). Available at: www.pediatrics.org/cgi/content/full/133/5/e1121 - PMC - PubMed
    1. Crain EF, Gershel JC. Urinary tract infections in febrile infants younger than 8 weeks of age. Pediatrics. 1990;86(3):363–367 - PubMed

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