Tags

Type your tag names separated by a space and hit enter

Screening for urinary tract infection in infants in the emergency department: which test is best?
Pediatrics. 1998 Jun; 101(6):E1.Ped

Abstract

OBJECTIVE

Comparison of rapid tests and screening strategies for detecting urinary tract infection (UTI) in infants.

METHODS

Cross-sectional study conducted in an urban tertiary care children's hospital emergency department and clinical laboratories of 3873 infants <2 years of age who had a urine culture obtained in the emergency department by urethral catheterization; results of urine dipstick tests for leukocyte esterase or nitrites, enhanced urinalysis (UA) (urine white blood cell count/mm3 plus Gram stain), Gram stain alone, and dipstick plus microscopic UA (white blood cells and bacteria per high-powered field) compared with urine culture results (positive urine results defined as >/=10 colony-forming units per milliliter of urinary tract pathogen) for each sample. Cost comparison of 1) dipstick plus culture of all urine specimens versus 2) cell count +/- Gram stain of urine, culture only those with positive results.

RESULTS

The enhanced UA was most sensitive at detecting UTI (94%; 95% confidence interval: 83,99), but had more false-positive results (16%) than the urine dipstick or Gram stain (3%). The most cost-effective strategy was to perform cultures on all infants and begin presumptive treatment on those whose dipstick had at least moderate (+2) leukocyte esterase or positive nitrite at a cost of $3.70 per child. With this strategy, all infants with UTI were detected. If the enhanced UA was used to screen for when to send the urine for culture, 82% of cultures would be eliminated, but 4% to 6% of infants with UTI would be missed and the cost would be higher ($6.66 per child).

CONCLUSION

No rapid test can detect all infants with UTI. Physicians should send urine for culture from all infants and begin presumptive treatment only on those with a significantly positive dipstick result. The enhanced UA is most sensitive for detecting UTI, but is less specific and more costly, and should be reserved for the neonate for whom a UTI should not be missed at first visit.

Authors+Show Affiliations

Shaw KN
Department of Pediatrics, Children's Hospital of Philadelphia, PA 19104, USA.
McGowan KL
No affiliation info available
Gorelick MH
No affiliation info available
Schwartz JS
No affiliation info available

MeSH

Bacteriological TechniquesCross-Sectional StudiesEmergency Service, HospitalEvaluation Studies as TopicFemaleHumansInfantLeukocyte CountMalePredictive Value of TestsProspective StudiesReagent StripsSensitivity and SpecificityUrinalysisUrinary Tract InfectionsUrine

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

9606243

Citation

Shaw, K N., et al. "Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best?" Pediatrics, vol. 101, no. 6, 1998, pp. E1.
Shaw KN, McGowan KL, Gorelick MH, et al. Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatrics. 1998;101(6):E1.
Shaw, K. N., McGowan, K. L., Gorelick, M. H., & Schwartz, J. S. (1998). Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatrics, 101(6), E1.
Shaw KN, et al. Screening for Urinary Tract Infection in Infants in the Emergency Department: Which Test Is Best. Pediatrics. 1998;101(6):E1. PubMed PMID: 9606243.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Screening for urinary tract infection in infants in the emergency department: which test is best? AU - Shaw,K N, AU - McGowan,K L, AU - Gorelick,M H, AU - Schwartz,J S, PY - 1998/6/2/pubmed PY - 1998/6/2/medline PY - 1998/6/2/entrez SP - E1 EP - E1 JF - Pediatrics JO - Pediatrics VL - 101 IS - 6 N2 - OBJECTIVE: Comparison of rapid tests and screening strategies for detecting urinary tract infection (UTI) in infants. METHODS: Cross-sectional study conducted in an urban tertiary care children's hospital emergency department and clinical laboratories of 3873 infants <2 years of age who had a urine culture obtained in the emergency department by urethral catheterization; results of urine dipstick tests for leukocyte esterase or nitrites, enhanced urinalysis (UA) (urine white blood cell count/mm3 plus Gram stain), Gram stain alone, and dipstick plus microscopic UA (white blood cells and bacteria per high-powered field) compared with urine culture results (positive urine results defined as >/=10 colony-forming units per milliliter of urinary tract pathogen) for each sample. Cost comparison of 1) dipstick plus culture of all urine specimens versus 2) cell count +/- Gram stain of urine, culture only those with positive results. RESULTS: The enhanced UA was most sensitive at detecting UTI (94%; 95% confidence interval: 83,99), but had more false-positive results (16%) than the urine dipstick or Gram stain (3%). The most cost-effective strategy was to perform cultures on all infants and begin presumptive treatment on those whose dipstick had at least moderate (+2) leukocyte esterase or positive nitrite at a cost of $3.70 per child. With this strategy, all infants with UTI were detected. If the enhanced UA was used to screen for when to send the urine for culture, 82% of cultures would be eliminated, but 4% to 6% of infants with UTI would be missed and the cost would be higher ($6.66 per child). CONCLUSION: No rapid test can detect all infants with UTI. Physicians should send urine for culture from all infants and begin presumptive treatment only on those with a significantly positive dipstick result. The enhanced UA is most sensitive for detecting UTI, but is less specific and more costly, and should be reserved for the neonate for whom a UTI should not be missed at first visit. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/9606243/Screening_for_urinary_tract_infection_in_infants_in_the_emergency_department:_which_test_is_best DB - PRIME DP - Unbound Medicine ER -