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.
| Language | English (US) |
|---|---|
| Article number | e20173068 |
| Journal | Pediatrics |
| Volume | 141 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2018 |
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ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
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Accuracy of the urinalysis for urinary tract infections in febrile infants 60 days and younger. / Tzimenatos, Leah S; Mahajan, Prashant; Dayan, Peter S.; Vitale, Melissa; Linakis, James G.; Blumberg, Stephen; Borgialli, Dominic; Ruddy, Richard M.; Buren, John Van; Ramilo, Octavio; Kuppermann, Nathan.
In: Pediatrics, Vol. 141, No. 2, e20173068, 01.02.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Accuracy of the urinalysis for urinary tract infections in febrile infants 60 days and younger
AU - Tzimenatos, Leah S
AU - Mahajan, Prashant
AU - Dayan, Peter S.
AU - Vitale, Melissa
AU - Linakis, James G.
AU - Blumberg, Stephen
AU - Borgialli, Dominic
AU - Ruddy, Richard M.
AU - Buren, John Van
AU - Ramilo, Octavio
AU - Kuppermann, Nathan
PY - 2018/2/1
Y1 - 2018/2/1
N2 - 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.
AB - 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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U2 - 10.1542/peds.2017-3068
DO - 10.1542/peds.2017-3068
M3 - Article
VL - 141
JO - Pediatrics
T2 - Pediatrics
JF - Pediatrics
SN - 0031-4005
IS - 2
M1 - e20173068
ER -