Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits

Coulthard, Malcolm; Lambert, H; Vernon, Sue; Hunter, Elizabeth W; Keir, M.J.; Matthews, J. N. S.

doi:10.1136/archdischild-2013-304428

Cited by 63 publications

(44 citation statements)

References 26 publications

(26 reference statements)

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“…A delay in treatment has been associated with a higher likelihood of renal scarring. [8][9][10][11] This may partly explain why, in a recent meta-analysis, children with UTIs caused by non-E coli organisms were more likely to develop renal scarring. 12 Our results suggest that pyuria may not always be present in children with UTIs, especially those caused by Enterococcus species, Klebsiella species, or P aeruginosa.…”

Section: Figurementioning

confidence: 99%

Association Between Uropathogen and Pyuria

et al. 2016

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OBJECTIVE: We sought to determine factors associated with the absence of pyuria in symptomatic children whose urine culture was positive for a known uropathogen. METHODS:We obtained data on children evaluated at the Children's Hospital of Pittsburgh emergency department between 2007 and 2013 with symptoms of urinary tract infection (UTI) who had paired urinalysis and urine cultures. We excluded children with an unknown or bag urine collection method, major genitourinary anomalies, immunocompromising conditions, or with multiple organisms on culture. We chose a single, randomly-selected urine specimen per child and limited the analysis to those with positive cultures.RESULTS: There were 46 158 visits during the study period; 1181 children diagnosed with UTI met all inclusion criteria and had a microscopic urinalysis for pyuria. Pyuria (≥5 white blood cells per high-powered field or ≥10 white blood cells per cubic millimeter) was present in 1031 (87%) children and absent in 150 (13%). Children with Enterococcus species, Klebsiella species, and Pseudomonas aeruginosa were significantly less likely to exhibit pyuria than children with Escherichia coli (odds ratio of 0.14, 0.34, and 0.19, respectively). Children with these organisms were also less likely to have a positive leukocyte esterase on dipstick urinalysis. Results were similar when we restricted the analysis to children whose urine samples were collected by bladder catheterization. CONCLUSIONS:We found that certain uropathogens are less likely to be associated with pyuria in symptomatic children. Identification of biomarkers more accurate than pyuria or leukocyte esterase may help reduce over-and undertreatment of UTIs.

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Section: Figurementioning

confidence: 99%

Association Between Uropathogen and Pyuria

et al. 2016

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“…4 A recent study emphasised the importance of prompt and empirical antibiotic treatment of childhood UTI. 5 When the threshold for prescribing antibiotics for children with non-specific symptoms is low, children with 'occult UTI' may be serendipitously treated for their UTI. 6 A small UK study found that children with UTI that had not been suspected by the GP had all received antibiotics (amoxicillin) for alternative infections.…”

Section: Introductionmentioning

confidence: 99%

Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery

Butler

O’Brien²,

Pickles

et al. 2015

Br J Gen Pract

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“…Timely diagnosis and antibiotic therapy are necessary to reduce the risk of serious complications from UTI (2). However, due to nonspecific manifestations, UTI requires a high degree of suspicion, which in turn has contributed to both underand overdiagnosis (3,4).…”

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Lack of Clinical Utility of Urine Gram Stain for Suspected Urinary Tract Infection in Pediatric Patients

et al. 2015

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bUrinary tract infection (UTI) is one of the most common infections in children. Urine culture remains the gold standard for diagnosis, but the utility of urine Gram stain relative to urinalysis (UA) is unclear. We reviewed 312 pediatric patients with suspected UTI who had urine culture, UA, and urine Gram stain performed from a single urine specimen. UA was considered positive if >10 leukocytes per oil immersion field were seen or if either nitrates or leukocyte esterase testing was positive. Urine Gram stain was considered positive if any organisms were seen. Sensitivity, specificity, and positive and negative predictive values were calculated using urine culture as the gold standard. Thirty-seven (12%) patients had a culture-proven UTI. Compared to urine Gram stain, UA had equal sensitivity (97.3% versus 97.5%) and higher specificity (85% versus 74%). Empirical therapy was prescribed before the Gram stain result was known in 40 (49%) patients and after in 42 (51%) patients. The antibiotics chosen did not differ between the two groups (P ‫؍‬ 0.81), nor did they differ for patients with Gram-negative rods on urine Gram stain compared to those with Gram-positive cocci (P ‫؍‬ 0.67). From these data, we conclude that UA has excellent negative predictive value that is not enhanced by urine Gram stain and that antibiotic selection did not vary based on the urine Gram stain result. In conclusion, the clinical utility of urine Gram stain does not warrant the time or cost it requires. U rinary tract infection (UTI) is one of the most common infections in children, accounting for up to 2% of pediatric hospital admissions at an annual cost of more than half a billion dollars (1). Timely diagnosis and antibiotic therapy are necessary to reduce the risk of serious complications from UTI (2). However, due to nonspecific manifestations, UTI requires a high degree of suspicion, which in turn has contributed to both underand overdiagnosis (3, 4). The need for timely antibiotic therapy necessitates the use of rapid diagnostic tests in addition to urine culture, notably, urinalysis (UA) and urine Gram stain. However, the utility of urine Gram stain relative to UA remains controversial. Previous studies have supported the use of urine Gram stain, urinalysis, or both as a screening test (5-8). However, the most recent American Academy of Pediatrics guidelines for the management of UTI in children 2 to 24 months of age does not include Gram stain as part of the diagnosis (9). Furthermore, significant resources are required to perform urine Gram stain in a timely manner, including microbiology technician time. The objectives of our study were to identify the sensitivity and specificity of UA and urine Gram stain and to determine whether urine Gram stain has utility in diagnosis or optimal antimicrobial prescribing for pediatric UTI. MATERIALS AND METHODS Patient cohort.We retrospectively included all patients aged Յ19 years of age who had a urine culture, urinalysis, and urine Gram stain ordered on a single urine specimen between 28...

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Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits

Cited by 63 publications

References 26 publications

Association Between Uropathogen and Pyuria

Association Between Uropathogen and Pyuria

Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery

Lack of Clinical Utility of Urine Gram Stain for Suspected Urinary Tract Infection in Pediatric Patients

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