Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children

Abstract

IMPORTANCE Accurately estimating the probability of urinary tract infection (UTI) in febrile preverbal children is necessary to appropriately target testing and treatment.OBJECTIVE To develop and test a calculator (UTICalc) that can first estimate the probability of UTI based on clinical variables and then update that probability based on laboratory results. DESIGN, SETTING, AND PARTICIPANTS Review of electronic medical records of febrile children aged 2 to 23 months who were brought to the emergency department of Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. An independent training database comprising 1686 patients brought to the emergency department between January 1, 2007, and April 30, 2013, and a validation database of 384 patients were created. Five multivariable logistic regression models for predicting risk of UTI were trained and tested. The clinical model included only clinical variables; the remaining models incorporated laboratory results. Data analysis was EXPOSURES Documented temperature of 38°C or higher in children aged 2 months to less than 2 years. MAIN OUTCOMES AND MEASURES With the use of culture-confirmed UTI as the main outcome, cutoffs for high and low UTI risk were identified for each model. The resultant models were incorporated into a calculation tool, UTICalc, which was used to evaluate medical records. RESULTS A total of 2070 children were included in the study. The training database comprised 1686 children, of whom 1216 (72.1%) were female and 1167 (69.2%) white. The validation database comprised 384 children, of whom 291 (75.8%) were female and 200 (52.1%) white. Compared with the American Academy of Pediatrics algorithm, the clinical model in UTICalc reduced testing by 8.1% (95% CI, 4.2%-12.0%) and decreased the number of UTIs that were missed from 3 cases to none. Compared with empirically treating all children with a leukocyte esterase test result of 1+ or higher, the dipstick model in UTICalc would have reduced the number of treatment delays by 10.6% (95% CI, 0.9%-20.4%).CONCLUSIONS AND RELEVANCE UTICalc estimates the probability of UTI by evaluating the risk factors present in the individual child. As a result, testing and treatment can be tailored, thereby improving outcomes for children with UTI.

Trends in Antimicrobial Susceptibility of Escherichia coli Isolates in a Taiwanese Child Cohort with Urinary Tract Infections between 2004 and 2018

“…If broad-spectrum antibiotic empirical therapy were to be considered for severe symptoms and/or potential risk factors of 3GC-resistant uropathogens, it would have implications for antimicrobial stewardship to reduce the risk of inadequate antimicrobial treatment. A predictive algorithm (UTICalc calculator) that incorporates clinical and laboratory results has been proposed to assist clinicians in identifying UTIs in febrile children younger than two years [36]. The development of a predictive model, by evaluating the risk factors for antibiotic resistance to E. coli may be useful to assist in providing empirical antibiotic therapy recommendations.…”

Urine Specific Gravity and the Accuracy of Urinalysis

“…Because clinicians ultimately will need to make a dichotomous (yes versus no) decision regarding the use of antibiotics, we dichotomized the obtained probabilities using a cutoff of 5% (ie, we assumed that children with a calculated probability of UTI of $5% are diagnosed with a UTI and treated with antibiotics). The 5% treatment threshold was based on previous studies, 4,5 which found that clinicians would likely treat a child for a UTI if the probability of UTI was between 5% and 25%. We then tallied the number of children in our database with true UTI who did not receive antibiotics (hereinafter referred to as "missed") and, likewise, the number of children without UTI who were inappropriately treated with antibiotics.…”

Pyelonephritis in Pediatric Uropathic Patients: Differences from Community-Acquired Ones and Therapeutic Protocol Considerations. A 10-Year Single-Center Retrospective Study

“…Furthermore, hospitals should be aware of the bacteria circulating in their geographical area as well as their antibiogram; this because the first therapeutic approach to PN is necessary empiric [ 16 , 17 ].…”