Does This Child Have a Urinary Tract Infection?

Shaikh, Nader; Morone, Natalia E.; López, J. Antonio G.; Chianese, Jennifer; Sangvai, Shilpa; D’Amico, Frank; Hoberman, Alejandro; Wald, Ellen R.

doi:10.1001/jama.298.24.2895

Cited by 208 publications

(158 citation statements)

References 27 publications

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“…This difference decreased in the 6-12-month group (7.3% and 0.3%) and there was no data available beyond infancy. Translated to likelihood ratios (LR), the uncircumcised male infant (3-24 months old) has a UTI LR of 2.8 versus 0.33 for circumcised males [33]. The risk increases if this infant is of non-black race.…”

Section: Level 2 Evidencementioning

confidence: 99%

CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

Davé

Afshar

Braga

et al. 2017

CUAJ

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Section: Level 2 Evidencementioning

confidence: 99%

CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

Davé

Afshar

Braga

et al. 2017

CUAJ

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“…Among the remaining studies, largely conducted in hospital EDs, abdominal pain, back pain, dysuria, frequency, and new-onset urinary incontinence increased the likelihood of a UTI. 29 Stridor, audible wheeze, circumcision, temperature <39ºC with a source, abnormal chest sounds, chest crackles, age ≤3 years, not feeling hot, and breathing difficulty decreased the likelihood of UTIs. The largest study, which included almost 16 000 children aged <5 years presenting to EDs in Australia, 26 derived a diagnostic model based on a combination of 27 symptoms and signs.…”

Section: 23mentioning

confidence: 99%

Nappy pad urine samples for investigation and treatment of UTI in young children: the ‘DUTY’ prospective diagnostic cohort study

et al. 2016

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Acutely unwell children <5 years presenting to 233 UK primary care sites. MethodLogistic regression to identify independent associations of symptoms, signs, and urine dipstick test results with UTI; diagnostic utility quantified as area under the receiver operator curves (AUROC). Nappy pad rule characteristics, AUROC, and contamination, compared with findings from clean-catch samples. ResultsNappy pad samples were obtained from 3205 children (82% aged <2 years; 48% female), culture results were available for 2277 (71.0%) and 30 (1.3%) had a UTI on culture. Female sex, smelly urine, darker urine, and the absence of nappy rash were independently associated with a UTI, with an internally-validated, coefficient model AUROC of 0.81 (0.87 for clean-catch), which increased to 0.87 (0.90 for clean-catch) with the addition of dipstick results. GPs' 'working diagnosis' had an AUROC 0.63 (95% confidence intervals [CI] = 0.53 to 0.72). A total of 12.2% of nappy pad and 1.8% of cleancatch samples were 'frankly contaminated' (risk ratio 6.66; 95% CI = 4.95 to 8.96; P<0.001). ConclusionNappy pad urine culture results, with features that can be reported by parents and dipstick tests, can be clinically useful, but are less accurate and more often contaminated compared with clean-catch urine culture.

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“…В недавно проведенном метаанализе [16] оцени-ли диагностическую точность признаков и симптомов ИМВП у младенцев 3-24 мес с лихорадкой (> 38°C) и детей старше 24 мес. У младенцев для постановки диа-гноза ИМВП наиболее достоверным оказалось наличие 2 или более следующих признаков: наличие в анамнезе эпизода ИМВП, лихорадка длительностью более 24 ч или выше 40°C, отсутствие циркумцизии у мальчиков и болезненность в надлобковой области.…”

Section: клинические проявленияunclassified

“…Для более старших детей самыми надежными были следую-щие симптомы: боли в животе с лихорадкой более 38°C, боли в спине, дебют недержания мочи, дизурия. Плохой запах мочи не был прогностическим признаком начала ИМВП [16].…”

Section: клинические проявленияunclassified

Urinary Tract Infection in Children

Маргиева¹,

Komarova²,

Костюшина³

et al. 2014

Pediatr. farmakol.

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путей, этиология, патогенез, клинические проявления, диагностика, лейкоцитурия, бактериурия, сбор мочи, лечение, антибактериальная терапия, профилактика, прогноз, новорожден-ные, младенцы, дети. (Педиатрическая фармакология. 2014; 11 (4): 124-128) Urinary Tract Infection in Children ВВЕДЕНИЕИнфекции мочевыводящих путей (ИМВП) -ведущая причина тяжелых бактериальных инфекций у младен-цев; наблюдаются у 7% детей младше 6 мес жизни и у 5% в возрасте от 6 до 24 мес [1]. ИМВП в период детства переносят в среднем до 10% девочек и 3% маль-чиков. Пузырно-мочеточниковый рефлюкс (ПМР) выяв-ляют после эпизода ИМВП, особенно у новорожденных и младенцев (в 36-49% случаев). В возрасте до 6 мес не наблюдается различий в частоте встречаемости ПМР у мальчиков и девочек [2,3]. ИМВП делят на осложнен-ные, протекающие с лихорадкой (чаще всего пиелонеф-рит), и неосложненные -без лихорадки (чаще инфек-ция нижних мочевыводящих путей). ЭТИОЛОГИЯ И ПАТОГЕНЕЗСреди возбудителей инфекций мочевыводящих путей у детей преобладает грамотрицательная фло-ра, при этом около 90% приходится на инфицирова-ние бактериями Escherichia coli. Грамположительные

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Does This Child Have a Urinary Tract Infection?

Cited by 208 publications

References 27 publications

CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

Nappy pad urine samples for investigation and treatment of UTI in young children: the ‘DUTY’ prospective diagnostic cohort study

Urinary Tract Infection in Children

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