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Microscopic Bacteriuria Detected by Automated Urinalysis for the Diagnosis of Urinary Tract Infection.
J Pediatr. 2018 11; 202:238-244.e1.JPed

Abstract

OBJECTIVE

To evaluate the test performance of microscopic bacteriuria by automated urinalysis for presumptive urinary tract infection (UTI) in young children.

STUDY DESIGN

This is a retrospective cross-sectional study of children aged <2 years evaluated for UTI in a single large emergency department with paired automated microscopic urinalysis and culture. Test characteristics were calculated for automated microscopic bacteriuria and pyuria, and a practical diagnostic threshold of bacteriuria was determined. Standard test performance measures and receiver operator characteristic curves were generated. The diagnostic performance of bacteriuria was compared with microscopic pyuria.

RESULTS

Two thousand five hundred fifty-four children with a median age of 6.1 months were studied, 19% of whom had a positive urine culture. Automated microscopic bacteriuria ≥1+ resulted in a positive likelihood ratio (LR+) of 4.5 (95% CI, 3.9-5.2) and negative LR (LR-) of 0.52 (95% CI, 0.47-0.57). Pyuria alone (≥5 WBC/high-power field) had a LR+ of 4.5 (95% CI, 4.1-5.0) and a LR- of 0.14 (95% CI, 0.11-0.18), whereas the addition of automated microscopic bacteriuria ≥1+ improved the LR+ to 16.3 (95% CI, 12.6-21.1) but raised the LR- to 0.51 (95% CI, 0.47-0.56). Test performance of automated microscopic bacteriuria measured by area under the curve analysis was lower (0.73; 95% CI, 0.70-0.76) than for pyuria (0.92; 95% CI, 0.90-0.93). Isolated automated microscopic bacteriuria without pyuria occurred in only 204 patients (8.0%), among whom only 20 (9.8%) had a positive urine culture.

CONCLUSIONS

Microscopic bacteriuria measured by automated urinalysis augments the diagnostic value of pyuria for identifying presumptive UTI in young children aged <2 years. Bacteriuria is diagnostically inferior to microscopic pyuria, and in children with bacteriuria without pyuria, presumptive UTI is unlikely.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Chaudhari PP
Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the USC, Los Angeles, CA.
Monuteaux MC
Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Bachur RG
Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.

MeSH

Academic Medical CentersAge DistributionArea Under CurveAutomationBacteriuriaChild, PreschoolCross-Sectional StudiesDatabases, FactualFemaleHospitals, PediatricHumansIncidenceInfantMalePredictive Value of TestsPyuriaROC CurveRetrospective StudiesSensitivity and SpecificitySeverity of Illness IndexSex DistributionUnited StatesUrinalysisUrinary Tract Infections

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30172436

Citation

Chaudhari, Pradip P., et al. "Microscopic Bacteriuria Detected By Automated Urinalysis for the Diagnosis of Urinary Tract Infection." The Journal of Pediatrics, vol. 202, 2018, pp. 238-244.e1.
Chaudhari PP, Monuteaux MC, Bachur RG. Microscopic Bacteriuria Detected by Automated Urinalysis for the Diagnosis of Urinary Tract Infection. J Pediatr. 2018;202:238-244.e1.
Chaudhari, P. P., Monuteaux, M. C., & Bachur, R. G. (2018). Microscopic Bacteriuria Detected by Automated Urinalysis for the Diagnosis of Urinary Tract Infection. The Journal of Pediatrics, 202, 238-e1. https://doi.org/10.1016/j.jpeds.2018.07.007
Chaudhari PP, Monuteaux MC, Bachur RG. Microscopic Bacteriuria Detected By Automated Urinalysis for the Diagnosis of Urinary Tract Infection. J Pediatr. 2018;202:238-244.e1. PubMed PMID: 30172436.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microscopic Bacteriuria Detected by Automated Urinalysis for the Diagnosis of Urinary Tract Infection. AU - Chaudhari,Pradip P, AU - Monuteaux,Michael C, AU - Bachur,Richard G, Y1 - 2018/08/29/ PY - 2018/03/21/received PY - 2018/06/20/revised PY - 2018/07/03/accepted PY - 2018/9/3/pubmed PY - 2019/3/5/medline PY - 2018/9/3/entrez KW - UTI KW - bacteria KW - diagnostics KW - pediatric KW - pyelonephritis KW - urinalysis SP - 238 EP - 244.e1 JF - The Journal of pediatrics JO - J Pediatr VL - 202 N2 - OBJECTIVE: To evaluate the test performance of microscopic bacteriuria by automated urinalysis for presumptive urinary tract infection (UTI) in young children. STUDY DESIGN: This is a retrospective cross-sectional study of children aged <2 years evaluated for UTI in a single large emergency department with paired automated microscopic urinalysis and culture. Test characteristics were calculated for automated microscopic bacteriuria and pyuria, and a practical diagnostic threshold of bacteriuria was determined. Standard test performance measures and receiver operator characteristic curves were generated. The diagnostic performance of bacteriuria was compared with microscopic pyuria. RESULTS: Two thousand five hundred fifty-four children with a median age of 6.1 months were studied, 19% of whom had a positive urine culture. Automated microscopic bacteriuria ≥1+ resulted in a positive likelihood ratio (LR+) of 4.5 (95% CI, 3.9-5.2) and negative LR (LR-) of 0.52 (95% CI, 0.47-0.57). Pyuria alone (≥5 WBC/high-power field) had a LR+ of 4.5 (95% CI, 4.1-5.0) and a LR- of 0.14 (95% CI, 0.11-0.18), whereas the addition of automated microscopic bacteriuria ≥1+ improved the LR+ to 16.3 (95% CI, 12.6-21.1) but raised the LR- to 0.51 (95% CI, 0.47-0.56). Test performance of automated microscopic bacteriuria measured by area under the curve analysis was lower (0.73; 95% CI, 0.70-0.76) than for pyuria (0.92; 95% CI, 0.90-0.93). Isolated automated microscopic bacteriuria without pyuria occurred in only 204 patients (8.0%), among whom only 20 (9.8%) had a positive urine culture. CONCLUSIONS: Microscopic bacteriuria measured by automated urinalysis augments the diagnostic value of pyuria for identifying presumptive UTI in young children aged <2 years. Bacteriuria is diagnostically inferior to microscopic pyuria, and in children with bacteriuria without pyuria, presumptive UTI is unlikely. SN - 1097-6833 UR - https://www.unboundmedicine.com/medline/citation/30172436/Microscopic_Bacteriuria_Detected_by_Automated_Urinalysis_for_the_Diagnosis_of_Urinary_Tract_Infection_ DB - PRIME DP - Unbound Medicine ER -