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Pitfalls of diagnosing urinary tract infection in infants and young children.
Pediatr Int. 2017 Jul; 59(7):786-792.PI

Abstract

BACKGROUND

The aim of this study was to examine the sensitivity and specificity of pyuria-based diagnosis of urinary tract infection (UTI) in urine collected by transurethral catheterization, and the reliability of diagnosis of pyuria in urine collected in a perineal bag. The gold standard for UTI diagnosis is significant colony counts of a single organism in urine obtained in a sterile manner.

METHODS

We enrolled 301 patients who underwent medical examination at the present hospital for possible UTI between January 2005 and December 2009. We collected 438 urine samples by transurethral catheterization. We investigated the accuracy of pyuria-based diagnosis of UTI using transurethral catheterization urine specimens, and the reliability of diagnosis of pyuria using bag-collected urine specimens.

RESULTS

The false-negative rate of UTI diagnosis based on pyuria in transurethral catheterization urine sediments was 9.0%; there was no significant difference in the false-negative rate of UTI diagnosis between boys and girls. Approximately 28% of pyuria-positive bag-collected urine specimens were pyuria negative on transurethral catheterization; this rate was significantly higher in girls than in boys (56.7% vs. 8.9%, P < 0.0001).

CONCLUSIONS

The absence of pyuria in transurethral catheterization urine sediments does not rule out UTI. Pyuria in bag-collected urine specimens frequently consists of urine leukocytes from external genitalia as well as from the urinary tract.

Authors+Show Affiliations

Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.Department of Biochemistry, Fukuoka University School of Medicine, Jonanku, Fukuoka, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28390079

Citation

Yamasaki, Yasuhito, et al. "Pitfalls of Diagnosing Urinary Tract Infection in Infants and Young Children." Pediatrics International : Official Journal of the Japan Pediatric Society, vol. 59, no. 7, 2017, pp. 786-792.
Yamasaki Y, Uemura O, Nagai T, et al. Pitfalls of diagnosing urinary tract infection in infants and young children. Pediatr Int. 2017;59(7):786-792.
Yamasaki, Y., Uemura, O., Nagai, T., Yamakawa, S., Hibi, Y., Yamamoto, M., Nakano, M., Kasahara, K., & Bo, Z. (2017). Pitfalls of diagnosing urinary tract infection in infants and young children. Pediatrics International : Official Journal of the Japan Pediatric Society, 59(7), 786-792. https://doi.org/10.1111/ped.13292
Yamasaki Y, et al. Pitfalls of Diagnosing Urinary Tract Infection in Infants and Young Children. Pediatr Int. 2017;59(7):786-792. PubMed PMID: 28390079.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pitfalls of diagnosing urinary tract infection in infants and young children. AU - Yamasaki,Yasuhito, AU - Uemura,Osamu, AU - Nagai,Takuhito, AU - Yamakawa,Satoshi, AU - Hibi,Yoshiko, AU - Yamamoto,Masaki, AU - Nakano,Masaru, AU - Kasahara,Katsuaki, AU - Bo,Zhang, PY - 2016/06/07/received PY - 2017/03/28/revised PY - 2017/04/04/accepted PY - 2017/4/9/pubmed PY - 2018/4/10/medline PY - 2017/4/9/entrez KW - accuracy of pyuria diagnosis KW - diagnosis of urinary tract infection KW - false-negative rate KW - urine collected by catheterization KW - urine collected using a urine bag SP - 786 EP - 792 JF - Pediatrics international : official journal of the Japan Pediatric Society JO - Pediatr Int VL - 59 IS - 7 N2 - BACKGROUND: The aim of this study was to examine the sensitivity and specificity of pyuria-based diagnosis of urinary tract infection (UTI) in urine collected by transurethral catheterization, and the reliability of diagnosis of pyuria in urine collected in a perineal bag. The gold standard for UTI diagnosis is significant colony counts of a single organism in urine obtained in a sterile manner. METHODS: We enrolled 301 patients who underwent medical examination at the present hospital for possible UTI between January 2005 and December 2009. We collected 438 urine samples by transurethral catheterization. We investigated the accuracy of pyuria-based diagnosis of UTI using transurethral catheterization urine specimens, and the reliability of diagnosis of pyuria using bag-collected urine specimens. RESULTS: The false-negative rate of UTI diagnosis based on pyuria in transurethral catheterization urine sediments was 9.0%; there was no significant difference in the false-negative rate of UTI diagnosis between boys and girls. Approximately 28% of pyuria-positive bag-collected urine specimens were pyuria negative on transurethral catheterization; this rate was significantly higher in girls than in boys (56.7% vs. 8.9%, P < 0.0001). CONCLUSIONS: The absence of pyuria in transurethral catheterization urine sediments does not rule out UTI. Pyuria in bag-collected urine specimens frequently consists of urine leukocytes from external genitalia as well as from the urinary tract. SN - 1442-200X UR - https://www.unboundmedicine.com/medline/citation/28390079/Pitfalls_of_diagnosing_urinary_tract_infection_in_infants_and_young_children_ DB - PRIME DP - Unbound Medicine ER -