The value of urinalysis in differentiating acute pyelnephritis from lower urinary tract infection in febrile infants

Landau, Daniel; Turner, Mary Ellen; Brennan, Jennifer; Majd, Massoud

doi:10.1097/00006454-199409000-00005

Cited by 30 publications

(9 citation statements)

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“…125,129,140,143,168 Two of these studies did not include an appropriate spectrum of patients. Three studies did not report sufficient information to assess the avoidance of disease progression bias, and three Tc-DMSA renal scintigraphy as the reference standard.…”

Section: Clinicalmentioning

confidence: 99%

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Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

Whiting¹,

Westwood²,

Bojke³

et al. 2006

Health Technol Assess

129

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The results of the systematic review were used to derive an algorithm for the diagnosis of UTI in children under 5. This algorithm represents the conclusions of the review in terms of effective practice. There were insufficient data to propose an algorithm for the further investigation of UTI in children under 5. The quality assessment highlighted several areas that could be improved upon in future diagnostic accuracy studies.

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Section: Clinicalmentioning

confidence: 99%

“…140 One study assessed the presence of physical symptoms or positive laboratory findings for the diagnosis of APN. 168 This study also used 99m…”

Section: Clinicalmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

Whiting¹,

Westwood²,

Bojke³

et al. 2006

Health Technol Assess

129

View full text Add to dashboard Cite

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“…A few children with growth Ͻ10 4 had evidence of pyuria and were treated for UTI, whereas 10% of children with Ն10 5 lacked evidence of pyuria. Although some of these children may have asymptomatic bacteriuria, the prevalence of asymptomatic bacteria is reported to be low, ϳ1%.19 However, pyuria as determined by standard urinalysis is not necessarily present on initial urinalysis even with documented pyelonephritis on nuclear scan in febrile young infants 20,21 or by suprapubic aspiration. …”

mentioning

confidence: 99%

Prevalence of Urinary Tract Infection in Febrile Young Children in the Emergency Department

et al. 1998

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ABSTRACT.Objective. Establish prevalence rates of urinary tract infection (UTI) in febrile infants and young girls in an emergency department (ED) by demographics and clinical parameters.Methods. Cross-sectional prevalence survey of 2411 (83%) of all infants younger than 12 months and girls younger than 2 years of age presenting to the ED with a fever (>38.5°C) who did not have a definite source for their fever and who were not on antibiotics or immunosuppressed. Otitis media, gastroenteritis, and upper respiratory infection were considered potential but not definite sources of fever.Results. Conclusions. UTI is prevalent in young children, particularly white girls, without a definite source of fever. Specific clinical signs and symptoms of UTI are uncommon, and the presence of another potential source of fever such as upper respiratory infection or otitis media is not reliable in excluding UTI. Pediatrics 1998;102(2). URL: http://www.pediatrics.org/cgi/content/full/102/2/ e16; UTI, evaluation of febrile infants, prevalence.ABBREVIATIONS. UTI, urinary tract infection; ED, emergency department; URI, upper respiratory infection; CI, confidence interval; WBC, white blood cell; GI, gastrointestinal. N uclear renal scans suggest that the vast majority of febrile young children with urinary tract infection (UTI) have pyelonephritis, putting them at risk for renal scarring and the longterm sequelae of hypertension and renal failure. [1][2][3][4] It is imperative that physicians identify these children to institute early treatment, evaluate the urinary tract, and monitor for recurrent UTI. 4 Unfortunately, the classic signs of UTI and pyelonephritis in older children and adults are not present or easily discerned in the toddler or young child. Fever is the most common symptom of UTI in the infant. 5,6 Also, the presence of another source of fever on examination, such as otitis media or other viral symptoms, does not exclude a UTI.7-9 Screening for UTI is uncomfortable for patients, time-consuming for staff, and expensive in the aggregate. Physicians throughout the United States vary in their clinical practice of when to obtain a urine culture in a febrile infant. 10,11Community studies suggest that boys younger than 1 year of age and girls younger than 5 years of age are most at risk for UTI. 5 The literature estimates that the prevalence of UTI in febrile children presenting for outpatient evaluation ranges from 1% to 20%. [7][8][9]12 The studies vary in their definition of UTI, method of urine collection, and eligibility criteria. Most have small sample sizes, and none have been true prevalence studies in which data are collected on all children.The aims of this study were 1) to establish prevalence rates of UTI among young febrile children seen in an urban emergency department (ED), and (2) to evaluate the effect of age, sex, race, and clinical symptoms and signs on the prevalence rates of UTI. METHODS Study Design and SubjectsThis was a cross-sectional study of the current clinical practice over a 1-year period...

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“…Their assessment can be influenced by other factors, such as the degree of hydration, method of specimen collection, mode of centrifugation, volume in which sediment is resuspended and subjective interpretation of results [183]. However, according to Landau et al [184], pyuria in febrile children is indicative of acute pyelonephritis. For all of these reasons, in neonates and children < 6 months of age, either pyuria, bacteriuria or the nitrite test, separately, have minimal predictive value for UTI [185,186] (LE: 3).…”

Section: G422 Quantification Of Bacteriuriamentioning

confidence: 99%

Urinary tract infection in patients with spinal cord injury after urodynamics under fosfomycin prophylaxis: a retrospective analysis

Amaral

Pereira

Rodrigues

et al. 2019

Porto Biomedical Journal

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Background: Urinary tract infection (UTI) is a common complication of spinal cord injury (SCI). Urodynamic testing is widely used for characterization of vesico-sphincteric dysfunction and for therapeutic orientation. As an invasive procedure, the risk of UTI is increased so, in some medical centers, antibiotic prophylaxis is instituted. Fosfomycin is one of the antibiotics used. Objective: The aim of this study was to evaluate the incidence of UTI after urodynamics in patients with SCI, under fosfomycin prophylaxis. Methods: Retrospective analysis was performed on patients with SCI, admitted to a rehabilitation center between January 2016 and June 2017, who underwent urodynamics studies under fosfomycin prophylaxis. Demographic data, risk factors for UTI—bacteriuria before urodynamics, high residual volume (>100 mL), bladder emptying method, vesico-sphincteric dyssynergia, and detrusor hyperactivity were analyzed. The incidence of UTI after urodynamics was evaluated. Results: The study included 84 patients, predominantly men 55 (65.5%). The mean age of the patients was 55.6 (18.9). Eleven (22.5%) had vesico-sphincteric dyssynergia, 32 (65.3%) detrusor hyperactivity and 22 (44.9%) had a high residual volume. Thirty-seven (44.1%) had asymptomatic bacteriuria before the urodynamics. Urinary complaints suggestive of UTI after urodynamics were observed in 2(2.4%) of patients, without significant bacteriuria and identification of bacterial agent. Conclusions: The incidence of UTI after invasive procedures is reported between 3% and 20% in the literature, so antibiotic prophylaxis has been instituted, although controversial. In the study, in none of the patients the diagnosis of UTI was confirmed. Fosfomycin prophylaxis may have been important in reducing the incidence of UTI.

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The value of urinalysis in differentiating acute pyelnephritis from lower urinary tract infection in febrile infants

Cited by 30 publications

References 0 publications

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

Prevalence of Urinary Tract Infection in Febrile Young Children in the Emergency Department

Urinary tract infection in patients with spinal cord injury after urodynamics under fosfomycin prophylaxis: a retrospective analysis

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