The Case Against Screening Urinalyses for Asymptomatic Bacteriuria in Children

Kemper, Kathi J.; Avner, Ellis D.

doi:10.1001/archpedi.1992.02160150083027

Cited by 22 publications

(11 citation statements)

References 35 publications

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“…However, both studies indicated that girls had a higher prevalence of heavy proteinuria than boys. The age-specific prevalence of other studies [12][13][14][15][16][17][18] and ours shows the prevalence increases with age and peaks at 13 years.…”

Section: Discussionsupporting

confidence: 64%

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The prevalence of heavy proteinuria and progression risk factors in children undergoing urinary screening

Lin

Sheng

Chen

et al. 2000

Pediatric Nephrology

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To evaluate the prevalence and incidence density of heavy proteinuria and chronic renal insufficiency (CRI) and the factors related to disease progression, 10,288,620 urinary screenings of elementary and junior high-school students from 1992 to 1996 were studied retrospectively. Urinary screening included pH, protein, occult blood, and glucose measurements. Blood sample analysis included total protein, albumin, A/G ratio, blood urea nitrogen, creatinine (Cr), antistreptolysin O titer, C3, cholesterol, hepatitis B virus surface antigen, IgA, and fasting blood sugar. The results showed that the 4-year prevalence of proteinuria was higher in girls than in boys (6.87x10(-4) vs. 4.83x10(-4) respectively). There were 189 cases with disease progression into CRI among the 10,288,620 students screened and followed continuously, with the prevalence of disease progression into CRI higher in boys than in girls (2.24x10(-5) vs. 1.41x10(-5) respectively). Of the 119 cases (63%) presenting with CRI since the first urine screening and blood sampling, only 14 had serum Cr levels higher than 6.0 mg/dl. There were 1,289 patients (10.5%) with proteinuria in 1992 and 705 patients (7.1%) in 1996. The absolute number of patients with heavy proteinuria decreased. The percentage of underlying glomerulonephritis in children on dialysis also decreased from 63.2% in 1992 to 47.0% in 1996. Logistic regression analysis showed that a persistent serum cholesterol level higher than 220 mg/dl, an albumin level lower than 3.5 g/dl, total protein less than 6 g/dl, and diastolic pressure higher than 90 mmHg were the significant risk factors for disease progression to CRI. We conclude that early detection of students with heavy proteinuria by mass urinary screening, early appropriate treatment, and monitoring of significant risk factors may help to decrease or delay the progression of renal disease, delay the introduction of dialysis in these predialysis CRI patients and maintain their growth and development.

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Section: Discussionsupporting

confidence: 64%

“…The most-important problem with urinalysis screening is false-positive or transient abnormalities [10][11][12][13][14][15]. Therefore, positive students undergo a second urinary screening 10-15 days later.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of heavy proteinuria and progression risk factors in children undergoing urinary screening

Lin

Sheng

Chen

et al. 2000

Pediatric Nephrology

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“…However, there is no generally accepted definition of asymptomatic bacteriuria after treatment of symptomatic UTI [20]. Furthermore, the occurrence of bacteriuria in a child without symptoms from the urinary tract is considered a benign condition best being left untreated [21,22].…”

Section: Discussionmentioning

confidence: 99%

Ceftibuten versus trimethoprim-sulfamethoxazole for oral treatment of febrile urinary tract infection in children

2009

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A randomized, open, coordinated multi-center trial compared the bacteriological and clinical efficacy and safety of orally administered ceftibuten and trimethoprim-sulfamethoxazole (TMP-SMX) in children with febrile urinary tract infection (UTI). Children aged 1 month to 12 years presenting with presumptive first-time febrile UTI were eligible for enrollment. A 2:1 assignment to treatment with ceftibuten 9 mg/kg once daily (n = 368) or TMP-SMX (3 mg + 15 mg)/kg twice daily (n = 179) for 10 days was performed. Escherichia coli was recovered in 96% of the cases. Among the E. coli isolates, 14% were resistant to TMP-SMX but none to ceftibuten. In the modified intention-to-treat population, the bacteriological elimination rates at follow-up did not differ significantly between patients treated with ceftibuten and those treated with TMP-SMX [91 vs. 95%, with a 95% confidence interval (CI) for difference of -9.7 to 1.0]. However, the clinical cure rate was significantly higher among those treated with ceftibuten (93 vs. 83%, with a 95% CI for difference of 2.4 to 17.0). Adverse events were similar for both regimens and consisted mainly of gastrointestinal disturbances. In conclusion, ceftibuten is a safe and effective drug for the empirical treatment of febrile UTI in young children.

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“…Approximately 1-2% of children (primarily girls) have asymptomatic bacteruria (14,23) Treatment of this benign condition with antibiotics is a poor decision as this is often followed by a symptomatic UTI (24). A recent adult study demonstrated that antibiotic therapy of asymptomatic bacteruria increase the chance that subsequent UTIs will be due to antibioticresistant organisms (25).…”

Section: Accurate Diagnosis Of Utimentioning

confidence: 99%

Management of urinary tract infections in children in an era of increasing antimicrobial resistance

Robinson

Saux

2016

Expert Review of Anti-infective Therapy

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The article reviews indications for and interpretation of urinalysis and urine culture results for diagnosis of UTI, choice of antibiotics for empiric and definitive UTI therapy, the rationale behind and indications for radiographic investigations, and prevention of UTIs including the complex decision as to whether antibiotic prophylaxis will benefit a child. Expert commentary: Over-diagnosis of UTI is a prevalent problem due to the lack of specificity of both urinalysis and urine culture. The most major recent advance in the field has been the recognition that antibiotic prophylaxis for UTI is rarely indicated as in most situations, the number needed to treat to prevent one UTI is too high to justify the risk of adverse events and development of antimicrobial resistance.

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The Case Against Screening Urinalyses for Asymptomatic Bacteriuria in Children

Cited by 22 publications

References 35 publications

The prevalence of heavy proteinuria and progression risk factors in children undergoing urinary screening

The prevalence of heavy proteinuria and progression risk factors in children undergoing urinary screening

Ceftibuten versus trimethoprim-sulfamethoxazole for oral treatment of febrile urinary tract infection in children

Management of urinary tract infections in children in an era of increasing antimicrobial resistance

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