Comparison of hemocytometer leukocyte counts and standard urinalyses for predicting urinary tract infections in febrile infants

Lin, Dar-Shong; Huang, Fu‐Yuan; Chiu, Nan-Chang; Koa, Hsin-An; Hung, Han-Yang; Hsu, Chyong-Hsin; Hsieh, Wen-Shyang; Yang, Dien-Ie

doi:10.1097/00006454-200003000-00010

Cited by 51 publications

(22 citation statements)

References 18 publications

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“…Hoberman et al 7 in 1996 and Shaw et al 20 in 1998 both evaluated enhanced urinalysis, consisting of more than 10 white blood cells in a counting chamber or any bacteria seen in 10 oil emersion fields; they found sensitivity of 94% to 96% and specificity of 84% to 93%. In 2000, Lin et al 21 found that a count of at least 10 white blood cells per L in a hemocytometer was less sensitive (83%) but quite specific (89%). Given the sensitivity of enhanced urinalysis, the probability of UTI for a typical febrile infant with a previous likelihood of UTI of 5% would be reduced to 0.2% to 0.4% with negative enhanced urinalysis results.…”

Section: Box 2: Diagnostic Tests For Utimentioning

confidence: 99%

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Finnell¹,

Carroll²,

Downs³

2011

Pediatrics

178

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OBJECTIVES: The diagnosis and management of urinary tract infections (UTIs) in young children are clinically challenging. This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial UTIs in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection. METHODS: The conceptual model presented in the 1999 technical report was updated after a comprehensive review of published literature. Studies with potentially new information or with evidence that reinforced the 1999 technical report were retained. Meta-analyses on the effectiveness of antimicrobial prophylaxis to prevent recurrent UTI were performed. RESULTS: Review of recent literature revealed new evidence in the following areas. Certain clinical findings and new urinalysis methods can help clinicians identify febrile children at very low risk of UTI. Oral antimicrobial therapy is as effective as parenteral therapy in treating UTI. Data from published, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI when vesicoureteral reflux is found through voiding cystourethrography. Ultrasonography of the urinary tract after the first UTI has poor sensitivity. Early antimicrobial treatment may decrease the risk of renal damage from UTI. CONCLUSIONS: Recent literature agrees with most of the evidence presented in the 1999 technical report, but meta-analyses of data from recent, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI. This finding argues against voiding cystourethrography after the first UTI.

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Section: Box 2: Diagnostic Tests For Utimentioning

confidence: 99%

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Finnell¹,

Carroll²,

Downs³

2011

Pediatrics

178

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Microscopymentioning

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

133

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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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“…We defined a positive urine result if the urine analysis counts were > 10 white blood cells (WBC)/high power field (hpf). This cutoff is based on likelihood to grow 10 5 bacterial colonies of the offending organism as demonstrated in pediatric patients presenting with sepsis from ages 0-3 months, as well as in adult patients presenting with urinary tract infection (8)(9)(10). Final positive urine culture was defined as those who grew more than 10 5 colony-forming units per milliliter of a single organism.…”

Section: Data Collection and Processingmentioning

confidence: 99%

Accuracy of Microscopic Urine Analysis and Chest Radiography in Patients with Severe Sepsis and Septic Shock

Capp

Chang

Brown

2012

The Journal of Emergency Medicine

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Comparison of hemocytometer leukocyte counts and standard urinalyses for predicting urinary tract infections in febrile infants

Abstract: Hemocytometer WBC counts provide more valid and precise prediction of UTI in febrile infants than standard UA. The presence of > or =10 WBC/microl in suprapubic aspiration specimens is the optimum cutoff value for identifying febrile infants for whom urine culture is warranted.

Cited by 51 publications

References 18 publications

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

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

Accuracy of Microscopic Urine Analysis and Chest Radiography in Patients with Severe Sepsis and Septic Shock

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