Evaluation of new American Academy of Pediatrics guideline for febrile urinary tract infection

Abstract

PurposeTo evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline.MethodsWe retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture but negative urinalysis findings), and group III (those with negative urine culture but positive urinalysis findings). Clinical, laboratory, and imaging results were analyzed and compared between the groups.ResultsA total of 300 children were enrolled. The serum C-reactive protein level was lower in children in group II than in those in groups I and III (P<0.05). Children in group I showed a higher frequency of hydronephrosis than those in groups II and III (P<0.05). However, the frequencies of acute pyelonephritis (APN), vesicoureteral reflux (VUR), renal scar, and UTI recurrence were not different between the groups. In group I, recurrence of UTI and presence of APN were associated with the incidence of VUR (recurrence vs. no recurrence: 40% vs.11.4%; APN vs. no APN: 23.3% vs. 9.2%; P<0.05). The incidence of VUR and APN was not related to the presence of hydronephrosis.ConclusionUTI in febrile children cannot be ruled out solely on the basis of positive urinalysis or urine culture findings. Recurrence of UTI and presence of APN may be reasonable indicators of the presence of VUR.

Diagnostic accuracy of urinary biomarkers in infants younger than 3 months with urinary tract infection

“…6) Urinalysis, including urine nitrites, is a helpful screening method to predict UTI; however, it alone may be inadequate due to its nonspecific nature. 4 7 8) Based on these findings, it is difficult to diagnose UTI early, especially in febrile infants without an identifiable source. Therefore, it is necessary to find quick, noninvasive, and reliable markers for the early diagnosis of UTI.…”

International Comparison of Causative Bacteria and Antimicrobial Susceptibilities of Urinary Tract Infections between Kobe, Japan, and Surabaya, Indonesia

“…However, Grampositive bacteria, such as Enterococcus, have become a representative causative agent of complicated UTIs in adults (5,6). On the other hand, pediatric UTIs are somewhat different from adult UTIs partly because of underlying diseases such as vesicoureteral reflux (VUR) (7). Thus, the UTI in a pediatric patient should be considered separately from one in adult patient.…”

Prediction of Renal Cortical Involvement Using Serum and Urinary Inflammatory Markers in Children with Febrile Urinary Tract Infection

“…In a study conducted by Choi et al (22), they divided children with febrile UTI into three groups: the group with abnormal urinalysis (U/A) and positive U/C, those with negative U/A and positive U/C, and cases with negative U/C and positive U/A findings. They found a lower serum level of CRP in children with only positive U/C compared with the other two groups.…”

“…No alternative as reference standard was available. Test positivity cut-offs or result categories of the index test were chosen based on literature review (12)(13)(14)(15)(16)(17)(21)(22)(23). Clinical information and reference standard results were not available to the performers/readers of the index test, and also clinical information and index test results were not available to the assessors of the reference standard.…”