Urinalysis in urinary tract infection

Abstract

In 376 children, between 6 months and 5 years of age, with suspected urinary tract infection, 4 parameters of a routine urine examination were correlated with culture reports. In diagnosing urinary infection, the sensitivity and specificity of proteinuria was 79 and 80% respectively, that of bacteriuria 78 and 96% and that of pyuria > 10 wbc/hpf 80 and 82% respectively. 61% among the culture positive groups had all these three parameter present, as against only 0.5% in the culture negative group (P < 0.001). All these 3 parameters were absent in 70% in the culture negative group, as against 8% in the culture positive group (P < 0.001). Bacteriuria in association with either proteinuria or Pyuria > 10 Wbc/hpf had 98% specialty is diagnosis. In diagnosis UTI, Pyuria > 10 wbc/hpf was significantly more specific (82:66.6) than the conventional > 5 wbc/hpf. Isolated proteinuria, isolated pyuria, isolated bacteriuria and microscopic haematuria were not features of urinary tract infection in children. Urine culture can be more selectively done if the routine urinalysis is well interpreted. In the absence of dependable culture facilities, a routine urine examination can be reliably used in the diagnosis of UTI in children.

Clinical and laboratory profile of urinary tract infection in febrile children aged 1 to 5 years

“…This is similar to observations made by John M et al who noted sensitivity of 78% and specificity of 96% using centrifuged urine sediments. 9 Bacteriuria occurring along with pyuria had a specificity of 98.3% in predicting infection which is similar to the observation made by Hoberman et al 9 Although microscopic urinalysis cannot substitute for a urine culture to document the presence of UTI, but it may be valuable in selecting patients for prompt initiation of antibiotic therapy while awaiting the results of urine culture.…”

“…6 When >20 WBC/HPF was considered, a sensitivity of 25% was found and specificity of 99.6%, while John Matthai et al recorded figures of 65% and 94% respectively. 9 In the present study, 12 (60%) patients with UTI and 5 (1.04%) patients without UTI had bacteria in their urine which was statistically significant. However, 8 (40%) cases with UTI would have been missed if presence of bacteria alone on microscopy was taken as a method of diagnosis for UTI.…”

“…10,6 John M et al correlated pyuria of varying levels (5, 10, 20) with culture positive cases and recommended using >10 WBC/HPF to define pyuria in centrifuged urine. 9 They noted that >5 WBC/HPF had sensitivity and specificity of 84% and 66.6% respectively, compared to 80% and 82% with >10 WBC/HPF. Using this definition of > 10 WBC/HPF, we found a sensitivity of 55% and specificity of 98.3% with higher positive predictive value (57.9%).…”

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

“…Several studies reported results for different cutoff points. 41,48,53,54,65,76,77,85,92,94,111 To prevent counting the same data twice, only one estimate from each of these studies was included in the analysis. Where possible, evaluations that reported a cut-off point of 10 WBC per high-power field (hpf) or per mm 3 , the cut-off most commonly used by studies in this section, were retained.…”

Clinical and Laboratory Profile of Children Birth to 12 Years Presenting With First Urinary Tract Infection (Uti) at a Tertiary Care Hospital

“…In the absence of dependable culture facilities, a routine urine examination can be reliably used in the diagnosis of urinary tract infection (UTI) in children. (13) In our study, E. coli was commonest organism and was isolated in 36(69.2%) cases, followed by Coagulase negative staphylococcus (CONS) in 5(9.6%) patients, Klebsiella pneumonia in 4(7.6%) patients, Pseudomonas aeruginosa in 2(3.8%), Proteus in 2(3.8%), Enterococcus in 2(3.8%). In a study by Mohammad A, Mohammad Sh, Asad U Khan on causative organisms and antibiotic sensitivity pattern of UTI in JNMC Hospital Aligarh, E. Coli was most common organism isolated (61%), followed by Klebsiella (22%), Staphylococcus (7%) and Pseudomonas (4%).…”