Rapid screening and microbiologic processing of pediatric urine specimens

Cannon, Harold J.; Goetz, E.; Hamoudi, Ayser C.; Marcon, Mario J.

doi:10.1016/0732-8893(86)90051-9

Cited by 24 publications

(6 citation statements)

References 18 publications

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“…Our sensitivities and specificities for dipstick analysis are similar to the 80% values reported by others studying pediatric patients [3,[6][7][8][9]. Unlike other reports [10,11], microscopy did not contribute to the detection of additional culture-positive urines if the dipstick results were negative.…”

Section: Discussionsupporting

confidence: 88%

Dipstick only urinalysis screen for the pediatric emergency room

Craver

Abermanis

1997

Pediatric Nephrology

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To determine if microscopic urinalysis is needed in all pediatric emergency room patients screened for urinary tract infections (UTI), we compared the dipstick urinalysis and complete urinalysis (dipstick and microscopy) with urine cultures in 236 children, aged 3 weeks to 21 years. The ability to detect UTI by dipstick only and by complete urinalysis was the same, however microscopic evaluation added many false-positive results without detecting additional UTIs. Because the ability to detect UTI (sensitivity) is maintained, we now offer a dipstick only urinalysis to our emergency room for children 2 years of age or older, with a microscopic analysis performed automatically if dipstick results are positive. If no microscopic urinalysis is required, testing turn-around time is reduced by 12.3 min/test and the hospital charge is reduced from U.S. $32 to U.S. $12.

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Section: Discussionsupporting

confidence: 88%

Dipstick only urinalysis screen for the pediatric emergency room

Craver

Abermanis

1997

Pediatric Nephrology

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“…Studies have shown that as many as 10% to 50% of patients with UTIs documented by positive UC can have a negative UA. 9–12 …”

mentioning

confidence: 99%

Can a Simple Urinalysis Predict the Causative Agent and the Antibiotic Sensitivities?

Waseem

Paudel²,

Sharma³

et al. 2014

Pediatric Emergency Care

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Objectives The objective of this study was (1) to determine the reliability of urinalysis (UA) for predicting urinary tract infection (UTI) in febrile children, (2) to determine whether UA findings can predict Escherichia coli versus non–E. coli urinary tract infection, and (3) to determine if empiric antibiotics should be selected based on E. coli versus non–E. coli infection predictions. Methods This was a retrospective chart review of children from 2 months to 2 years of age who presented to the emergency department with fever (rectal temperature >100.4°F) and had a positive urine culture. This study was conducted between January 2004 and December 2007. Negative UA was defined as urine white blood cell count less than 5 per high-power field, negative leukocyte esterase, and negative nitrites. Urine cultures were classified into E. coli and non–E. coli groups. These groups were compared for sex, race, and UA findings. Multivariate forward logistic regression, using the Wald test, was performed to calculate the likelihood ratio (LR) of each variable (eg, sex, race, UA parameters) in predicting UTI. In addition, antibiotic sensitivities between both groups were compared. Results Of 749 medical records reviewed, 608 were included; negative UA(−) was present in 183 cases, and positive UA(+) was observed in 425 cases. Furthermore, 424 cases were caused by E. coli, and 184 were due to non–E. coli organisms. Among 425 UA(+) cases, E. coli was identified in 349 (82.1%), whereas non–E. coli organisms were present in 76 (17.9%); in contrast, in 183 UA(−) cases, 108 (59%) were due to non–E. coli organisms versus 75 (41%), which were caused by E. coli. Urinalysis results were shown to be associated with organism group (P < 0.001). Positive leukocytes esterase had an LR of 2.5 (95% confidence interval [CI], 1.5–4.2), positive nitrites had an LR of 2.8 (95% CI, 1.4–5.5), and urine white blood cell count had an LR of 1.8 (95% CI, 1.3–2.4) in predicting E. coli versus non–E. coli infections. Antibiotic sensitivity compared between UA groups demonstrated equivalent superiority of cefazolin (94.7% sensitive in UA(+) vs 84.0% in UA(−) group; P < 0.0001), cefuroxime (98.2% vs 91.7%; P < 0.001), and nitrofurantoin (96.1% vs 82.2%; P < 0.0001) in the UA(+) group. In contrast, the UA(−) group showed significant sensitivity to trimethoprim-sulfamethoxazole (82.2% vs 71.3% in UA(+); P = 0.008). Conclusions Urinalysis is not an accurate predictor of UTI. A positive urine culture in the presence of negative UA most likely grew non–E. coli organisms, whereas most UA(+) results were associated with E. coli. This study also highlighted local patterns of antibiotic resistance between E. coli and non–E. coli groups. Negative UA results in the presence of strong suspicion of a UTI suggest a non–E. coli organism, which may be best treated with trimethoprim-sulfamethoxazole. Conversely, UA(+) results suggest E. coli, which calls for treatment with cefazolin or cefuroxime.

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“…is a 2-min enzyme dipstick test combining the leukocyte esterase and nitrite reactions. Ten clinical evaluations of 13,443 urine specimens reported test sensitivities ranging from 79 to 90% (5,11,25,32,53,56,59,71,75,81). When results of this test were compared with clinical findings rather than culture results and presence of WBC, the sensitivity was 84% (59).…”

Section: Enzymatic Methodsmentioning

confidence: 99%

Detection of urinary tract infections by rapid methods.

Pezzlo¹

1988

Clinical Microbiology Reviews

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Rapid screening and microbiologic processing of pediatric urine specimens

Cited by 24 publications

References 18 publications

Dipstick only urinalysis screen for the pediatric emergency room

Dipstick only urinalysis screen for the pediatric emergency room

Can a Simple Urinalysis Predict the Causative Agent and the Antibiotic Sensitivities?

Detection of urinary tract infections by rapid methods.

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