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Urinary tract infection in febrile infants younger than eight weeks of Age.
Pediatrics. 2000 Feb; 105(2):E20.Ped

Abstract

OBJECTIVE

To assess the usefulness of laboratory parameters, including peripheral white blood cell (WBC) count, C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and microscopic urinalysis (UA), for identifying febrile infants younger than 8 weeks of age at risk for urinary tract infection (UTI), and comparison of standard UA and hemocytometer WBC counts for predicting the presence of UTI.

METHODS

A total of 162 febrile children <8 weeks of age were enrolled in this prospective study. All underwent clinical evaluation and laboratory investigation, including WBC count and differential; ESR; CRP; blood culture; a lumbar puncture for cell count and differential, glucose level, protein level, Gram stain, and culture; and a UA and urine culture. All urine specimens were obtained by suprapubic aspiration and microscopically analyzed with standard UA as well as with hemocytometer WBC counts. Quantitative urine cultures were performed. Sensitivity, specificity, accuracy, likelihood ratios, and receiver operating characteristic (ROC) curves were determined for each of the screening tests.

RESULTS

There were 22 positive urine culture results of at least 100 colony-forming unit/mL. Eighteen of these 22 patients were males, and all were uncircumcised. There were significant differences for pyuria >/=5 WBCs/hpf, pyuria >/=10 WBC/microL, CRP >20 mg/L, and ESR >30 mm/hour between culture-positive and culture-negative groups (P <.05). The ROC area for hemocytometer WBC count, standard UA, peripheral WBC count, ESR, and CRP concentration were.909 +/-.045,.791 +/-.065,.544 +/-.074,. 787 +/-.060, and.822 +/-.036, respectively. The ROC curve analysis indicates that the CRP, ESR, and standard UA were powerful but imperfect tools with which to discriminate for UTI in potentially infected neonates. Hemocytometer WBC counts had the highest sensitivity, specificity, accuracy, and likelihood ratios for identifying very young infants with positive urine culture results. For all assessments, hemocytometer WBC counts were significantly different, compared with the standard urinalysis. ESR, CRP, and peripheral WBC counts were not helpful in identifying UTI in febrile infants.

CONCLUSION

UTI had a prevalence of 13.6% in febrile infants <8 weeks of age. The CRP, ESR, and standard UA were imperfect tools in discriminating for UTI, and the sensitivity of these laboratory parameters was relatively low. Hemocytometer WBC count was a significantly better predictor of UTI in febrile infants.

Authors+Show Affiliations

Lin DS
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Huang SH
No affiliation info available
Lin CC
No affiliation info available
Tung YC
No affiliation info available
Huang TT
No affiliation info available
Chiu NC
No affiliation info available
Koa HA
No affiliation info available
Hung HY
No affiliation info available
Hsu CH
No affiliation info available
Hsieh WS
No affiliation info available
Yang DI
No affiliation info available
Huang FY
No affiliation info available

MeSH

FemaleFeverHumansInfantInfant, NewbornLeukocyte CountMalePrevalenceProspective StudiesROC CurveSensitivity and SpecificityUrinalysisUrinary Tract Infections

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

10654980

Citation

Lin, D S., et al. "Urinary Tract Infection in Febrile Infants Younger Than Eight Weeks of Age." Pediatrics, vol. 105, no. 2, 2000, pp. E20.
Lin DS, Huang SH, Lin CC, et al. Urinary tract infection in febrile infants younger than eight weeks of Age. Pediatrics. 2000;105(2):E20.
Lin, D. S., Huang, S. H., Lin, C. C., Tung, Y. C., Huang, T. T., Chiu, N. C., Koa, H. A., Hung, H. Y., Hsu, C. H., Hsieh, W. S., Yang, D. I., & Huang, F. Y. (2000). Urinary tract infection in febrile infants younger than eight weeks of Age. Pediatrics, 105(2), E20.
Lin DS, et al. Urinary Tract Infection in Febrile Infants Younger Than Eight Weeks of Age. Pediatrics. 2000;105(2):E20. PubMed PMID: 10654980.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary tract infection in febrile infants younger than eight weeks of Age. AU - Lin,D S, AU - Huang,S H, AU - Lin,C C, AU - Tung,Y C, AU - Huang,T T, AU - Chiu,N C, AU - Koa,H A, AU - Hung,H Y, AU - Hsu,C H, AU - Hsieh,W S, AU - Yang,D I, AU - Huang,F Y, PY - 2000/2/2/pubmed PY - 2000/2/19/medline PY - 2000/2/2/entrez SP - E20 EP - E20 JF - Pediatrics JO - Pediatrics VL - 105 IS - 2 N2 - OBJECTIVE: To assess the usefulness of laboratory parameters, including peripheral white blood cell (WBC) count, C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and microscopic urinalysis (UA), for identifying febrile infants younger than 8 weeks of age at risk for urinary tract infection (UTI), and comparison of standard UA and hemocytometer WBC counts for predicting the presence of UTI. METHODS: A total of 162 febrile children <8 weeks of age were enrolled in this prospective study. All underwent clinical evaluation and laboratory investigation, including WBC count and differential; ESR; CRP; blood culture; a lumbar puncture for cell count and differential, glucose level, protein level, Gram stain, and culture; and a UA and urine culture. All urine specimens were obtained by suprapubic aspiration and microscopically analyzed with standard UA as well as with hemocytometer WBC counts. Quantitative urine cultures were performed. Sensitivity, specificity, accuracy, likelihood ratios, and receiver operating characteristic (ROC) curves were determined for each of the screening tests. RESULTS: There were 22 positive urine culture results of at least 100 colony-forming unit/mL. Eighteen of these 22 patients were males, and all were uncircumcised. There were significant differences for pyuria >/=5 WBCs/hpf, pyuria >/=10 WBC/microL, CRP >20 mg/L, and ESR >30 mm/hour between culture-positive and culture-negative groups (P <.05). The ROC area for hemocytometer WBC count, standard UA, peripheral WBC count, ESR, and CRP concentration were.909 +/-.045,.791 +/-.065,.544 +/-.074,. 787 +/-.060, and.822 +/-.036, respectively. The ROC curve analysis indicates that the CRP, ESR, and standard UA were powerful but imperfect tools with which to discriminate for UTI in potentially infected neonates. Hemocytometer WBC counts had the highest sensitivity, specificity, accuracy, and likelihood ratios for identifying very young infants with positive urine culture results. For all assessments, hemocytometer WBC counts were significantly different, compared with the standard urinalysis. ESR, CRP, and peripheral WBC counts were not helpful in identifying UTI in febrile infants. CONCLUSION: UTI had a prevalence of 13.6% in febrile infants <8 weeks of age. The CRP, ESR, and standard UA were imperfect tools in discriminating for UTI, and the sensitivity of these laboratory parameters was relatively low. Hemocytometer WBC count was a significantly better predictor of UTI in febrile infants. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/10654980/Urinary_tract_infection_in_febrile_infants_younger_than_eight_weeks_of_Age_ DB - PRIME DP - Unbound Medicine ER -