Biomarkers that differentiate false positive urinalyses from true urinary tract infection

Shaikh, Nader; Martin, Judith M.; Hoberman, Alejandro; Skae, Megan; Milkovich, Linette; McElheny, Christi L.; Hickey, Robert W.; Gabriel, Lucine; Kearney, Diana H.; Majd, Massoud; Shalaby‐Rana, Eglal; Tseng, George C.; Kolls, Jay K.; Horne, William; Huo, Zhiguang; Shope, Timothy R.

doi:10.1007/s00467-019-04403-7

Cited by 21 publications

(25 citation statements)

References 46 publications

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“…Elevated levels can be seen in a variety of other diseases, where the immune system is activated for a shorter or longer period [ 23 ]. A promising solution for this is to find cytokine combinations for a specific disease and develop cytokine pattern studies [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

Biomarkers in urinary tract infections – which ones are suitable for diagnostics and follow-up?

Horváth¹,

Wullt

Naber

et al. 2020

GMS Infectious Diseases; 8:Doc24

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Section: Resultsmentioning

confidence: 99%

Biomarkers in urinary tract infections – which ones are suitable for diagnostics and follow-up?

Horváth¹,

Wullt

Naber

et al. 2020

GMS Infectious Diseases; 8:Doc24

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“…In this study, no distinction was made between nonfebrile and febrile UTIs. 34 Forster et al found that the urine NGAL levels were lower in girls under the age of 4 years whose urinalysis and symptoms suggest UTI, but with negative culture, than those with a true UTI. They reported that the AUC value of the urine NGAL level was greater than 0.9.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Urine Ribonuclease 7 (RNase 7) to Creatinine Ratio for Detecting Urinary Tract Infection in Children with Pyuria

Cetın

Kiraz

Gencler

2022

J Pediatr Infect Dis

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Objective Ribonuclease 7 (RNase 7) is one of the members of the antimicrobial peptides playing a role in maintaining urinary tract sterility. We aimed to investigate the predictive value of the urine RNase 7 levels in children with pyuria and associations between RNase 7 and vesicoureteral reflux (VUR) and renal scarring. Methods This study included 109 children with pyuria (46 febrile urinary tract infections [UTIs], 38 nonfebrile UTIs, and 25 sterile pyuria) whose RNase 7 levels were measured by enzyme-linked immunoassay. The results for urine RNase 7 concentrations were expressed as micrograms per milligrams creatinine. Results RNase 7/Cr levels were higher in patients with both febrile and nonfebrile UTIs than the patients with sterile pyuria (p = 0.001). RNase 7/Cr had predictive values of diagnosis of febrile and nonfebrile UTIs (cut-off value: 2.92 µg/mg, p = 0.003; cut-off value: 3.67 µg/mg, p < 0.001, respectively). RNase 7/Cr had higher levels in the patients with VUR than without VUR (cut-off value: 4.28 µg/mg, p = 0.037). The patients with renal scarring had higher urine RNase 7/Cr than those without scarring (cut-off value: 4.54 µg/mg, p = 0.041). Conclusion The evaluation of RNase 7/Cr may help prevent unnecessary and/or inappropriate antibiotic use in children with pyuria. The higher RNase 7 levels in patients with VUR and renal scarring may reflect long-term inflammation or greater inflammatory response during acute infection.

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“…A potential method to deal with this clinical uncertainty is to empirically treat the high-risk group—those in whom the clinician has a high degree of suspicion for UTI and those at risk of complications, such as scarring. There are several novel candidate urinary biomarkers that may have greater predictive accuracy for UTI than the traditional UA and urine microscopy 20–22 . Such biomarkers may play a future role in aiding clinical decisions around empiric antibiotic use for children being evaluated for UTIs.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Empiric Antibiotic Use in the Emergency Department in Children Without Urinary Tract Infections

et al. 2021

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ObjectivesUrinary tract infections (UTIs) are a common diagnosis within the pediatric emergency department (ED). Because of the necessary delay in obtaining urine culture results, clinicians must decide whether to prescribe antibiotics for a suspected UTI before urine culture results. The primary objective of this study was to identify the proportion of children given empiric antibiotics who subsequently did not meet consensus definition of an UTI. The secondary objective was to identify factors associated with return visits to the ED after an index visit for UTI. We also attempted to identify predictors of prescription of empiric antibiotics for children who did not have a UTI.MethodsThis was a retrospective chart review of all patients between the ages of 2 months and 18 years diagnosed with a UTI between July 2016 and June 2017 in the ED of a single urban quaternary care center. Patients were excluded for the following reasons: use of bag for urine collection, subsequent admission to the hospital, receipt of antibiotics within the previous 3 days, use of antibiotics for an indication other than a UTI, and urine culture obtained at an outside facility.ResultsOf 404 included patients, 389 (96.2%) were discharged on antibiotics and 243 (62.4%) did not have a UTI. On the multivariate analysis, age ≧ 36 months was associated with increased odds of receiving antibiotics and not having a UTI while both ≥1+ leukocyte esterase and ≥1+ nitrites on urinalysis were associated with decreased odds of receiving antibiotics and not meeting UTI criteria. Sixty-two patients revisited the ED within 30 days of the initial visit, 24 (38.7%) of which met criteria for UTI during the index visit. Prescription of antibiotics at the time of the index visit was associated with decreased odds of reutilization, whereas an extended-spectrum β-lactamase producing organism cultured from urine at the index visit was associated with increased odds of reutilization.ConclusionsA high number of patients discharged on empiric antibiotics did not meet criteria for a UTI. We did not identify clinically useful factors that predicted prescription of empiric antibiotics for children who do not have a UTI. We believe that unnecessary antibiotic prescriptions could be substantially decreased by decreasing empiric use of antibiotics coupled with reliable follow-up for positive urine cultures.

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Biomarkers that differentiate false positive urinalyses from true urinary tract infection

Cited by 21 publications

References 46 publications

Biomarkers in urinary tract infections – which ones are suitable for diagnostics and follow-up?

Biomarkers in urinary tract infections – which ones are suitable for diagnostics and follow-up?

Diagnostic Value of Urine Ribonuclease 7 (RNase 7) to Creatinine Ratio for Detecting Urinary Tract Infection in Children with Pyuria

Predictors of Empiric Antibiotic Use in the Emergency Department in Children Without Urinary Tract Infections

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