Circumcision for the prevention of significant bacteriuria in boys

Nayır, Ahmet

doi:10.1007/s004670100044

Cited by 42 publications

(23 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…84,85 It has been suggested that obtaining two samples from children in primary care would reduce the risk of false-positive results; 80 however, it is unlikely that this would prove successful in primary care given the challenges and current low levels of urine sampling. It is also unclear if two samples would improve validity as there may be a greater number of false-negative results with this technique.…”

Section: Bacteriuria Thresholdmentioning

confidence: 99%

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

Hay

Birnie²,

Busby³

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundIt is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment.ObjectivesTo develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness.DesignMulticentre, prospective diagnostic cohort study.Setting and participantsChildren < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms.MethodsOne hundred and seven clinical characteristics (index tests) were recorded from the child’s past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood (‘clinical diagnosis’) and urine sampling and treatment intentions (‘clinical judgement’) were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 105colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the ‘clinician diagnosis’ AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with ‘clinical judgement’.ResultsA total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, ‘clinical diagnosis’ correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were < 2 years old and 1.3% met the UTI definition. ‘Clinical diagnosis’ correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut.ConclusionsClinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Bacteriuria Thresholdmentioning

confidence: 99%

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

Hay

Birnie²,

Busby³

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…The overall odds ratio (OR) for a UTI in circumcised males compared to uncircumcised males was 0.13 (95% CI, 0.07 to 0.23). The single RCT by Nayir et al included in this analysis, compared bacteriuria rates between circumcised and uncircumcised boys using bag or mid stream specimens and showed a non-statistically significant OR of 0.13 in the circumcised group (95% CI, 0.01 to 2.63) [35].…”

Section: Cuaj -Guidelinementioning

confidence: 91%

CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

Davé

Afshar

Braga

et al. 2017

CUAJ

View full text Add to dashboard Cite

“…Birçok çal›flmada sünnetin tüm yafl gruplar›nda özellik-le de süt çocuklar›nda ‹YE'ye karfl› koruyucu etkisi göste-rilmifltir (5)(6)(7)(8)(9)(10)(11)(12). Wiswell ve ark.…”

Section: Giriflunclassified

“…'lar› (8) okul ça¤› öncesi çocuklarda sünnetin ‹YE s›kl›-¤›n› azaltt›¤›n› göstermifller ve sünnetin ‹YE üzerine koruyucu etkisinin yafltan ba¤›ms›z oldu¤unu bildirmifllerdir. Nay›r (12), yenido¤an dönemi sonras› yap›lan sünnetin çocuklar-da bakteriüri ve bulgu veren ‹YE s›kl›¤›n› azaltt›¤›n› göster-mifltir. Spach ve ark.…”

Section: Tart›flmaunclassified

Çocuklarda sünnetin idrar yolu enfeksiyonu sıklığı üzerine etkisi

Özdemir¹,

Alpay²,

Bıyıklı³

et al. 2011

tpa

View full text Add to dashboard Cite

Ç Ço oc cu uk kl la ar rd da a s sü ün nn ne et ti in n i id dr ra ar r y yo ol lu u e en nf fe ek ks si iy yo on nu u s s› ›k kl l› ›¤ ¤› › ü üz ze er ri in ne e e et tk ki is si i E Ef ff fe ec ct t o of f c ci ir rc cu um mc ci is si io on n o on n u ur ri in na ar ry y t tr ra ac ct t i in nf fe ec ct ti io on n i in n b bo oy ys s N Ni ih ha al l Ö Öz zd de em mi ir r, , H Ha ar ri ik ka a A Al lp pa ay y, , N Ne efl fle e B B› ›y y› ›k kl l› ›, , ‹ ‹b br ra ah hi im m G Gö ök kç çe e, , A Ah hm me et t T To op pu uz zo o¤ ¤l lu u* * Ö Öz zg gü ün n A Ar ra afl flt t› ›r rm ma a O Or ri ig gi in na al l A Ar rt ti ic cl le e Ö Öz ze et t Amaç: Çocuklarda yenido¤an dönemi sonras› yap›lan sünnetin idrar yolu enfeksiyonu s›kl›¤› üzerine etkisini de¤erlendirmektir. Gereç ve Yöntem: ‹drar yolu enfeksiyonu geçiren yafllar› 1-70 ay (ortanca 5 ay) aras›nda 56 erkek çocuk çal›flmaya al›nd›. Tüm hastalara böbrek ultrasonografisi ve dimerkaptosüksinik asit sintigrafisi baflvuruda uyguland›. "‹fleme sistoüretrografisi" seçilmifl hastalara yap›ld›. Otuz-üç hastada vezikoüreteral reflü tespit edilmedi, 23 hastada 1-3 dereceli vezikoüreteral reflü vard›. Hastalardan düzenli aral›klarla idrar kültürleri al›nd›, idrar yolu enfeksiyonu idrar kültüründe >10 5 cfu/ml tek bir organizman›n üremesi olarak tan›mland›. ‹drar örne¤i bafl›na (say›) ve takip süresi (ay) boyunca geçirilen idrar yolu enfeksiyonu s›kl›¤› sünnet öncesi ve sonras› de¤erlendirilerek karfl›laflt›r›ld›. S Su um mm ma ar ry yAim: To assess the effect of circumcision after the newborn period on recurrence of urinary tract infections (UTI) in boys. Material and Method: Fifty-six boys ranging in age from 1 to 70 months (median 5 months) with UTI were evaluated retrospectively. Renal ultrasonography and dimercaptosuccinic acid scan were performed in all patients at admission. Voiding-cystourethrography was performed in selected patients. Thirty-three boys had no underlying vesicoureteral reflux (VUR), 23 boys had VUR grade 1-3. Regular urine samples were cultured to detect UTI, defined as a single species with >10 5 colony-forming units/ml. Number of UTI per urine sample (number) and per follow-up time (month) were compared before and after circumcision. Results: In the whole group; median UTI per sample was 0.33 (IR; 0.21) before circumcision and 0.0 (IR; 0.50) after circumcision, median UTI per month was 0.37 (IR; 0.51) before circumcision and 0.0 (IR; 0.0) after circumcision. When the analysis was done seperately, UTI episodes were significantly lower after circumcision both in patients with no underlying urinary tract anomaly and patients with low grade reflux.Conclusions: This study suggests that circumcision after the newborn period decreases recurrence of urinary tract infections in preschool boys with and without reflux. (Turk Arch Ped 2010; 45: 137-40) Key words: Child, circumcision, urinary tract infection 1 13 37 7 GiriflÇocukluk ça¤›nda idrar yoalu enfeksiyonlar› (‹YE) oldukça s›kt›r ve ilk 10 yaflta erkek çocuklar›n›n yaklafl›k %1, k›z çocuklar›n›n i...

show abstract

Circumcision for the prevention of significant bacteriuria in boys

Cited by 42 publications

References 42 publications

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

Çocuklarda sünnetin idrar yolu enfeksiyonu sıklığı üzerine etkisi

Contact Info

Product

Resources

About