Pitfalls of diagnosing urinary tract infection in infants and young children

Yamasaki, Yasuhito; Uemura, Osamu; Nagai, Takuhito; Yamakawa, Satoshi; Hibi, Yoshiko; Yamamoto, Masaki; Nakano, Masaru; Kasahara, Katsuaki; Zhang, Bo

doi:10.1111/ped.13292

Cited by 11 publications

(3 citation statements)

References 16 publications

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“…A Brazilian study using pads reported that the rate of contamination of urine with bacteria was similar to the use of pads and urine bags and was significantly higher compared to clean-catch midstream urine [ 19 ]. Pyuria in bag-collected urine specimens might consist of leukocytes from the external genitalia and urinary tract [ 20 ]. Since urine collected in absorbable pads is usually contaminated, the novel urine collection kit using urine filter paper in this study is not useful for the diagnosis of urinary tract infections.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of a Novel Urine Collection Kit Using Filter Paper in Neonates: An Observational Study

Nagano

Imaizumi

et al. 2021

Children

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Urine bags are commonly used to collect urine samples from neonates. However, the sample can be contaminated by stool, or detachment of the bag due to body movement can lead to failure of the collection. A qualitative urine collection kit containing ten filter papers of 3.2 mm diameter was developed and clinically verified among 138 neonates. During a single diaper change (approximately 3 h), the rate of urine collection was calculated. Urine collection was considered to be successful if any filter paper in the urine collection sheet turned from blue to white. Of the 127 neonates who passed urine, 122 had a change in the filter paper. The urine collection rate was 96%, with changes in all 10 filter papers observed in 98 neonates (80%). Urine collection rate was not influenced by sex (p = 1.00), age at collection (p = 0.72), preterm birth (p = 1.00), low birth weight (p = 0.92), or fecal contamination (p = 1.00). The incidence of dermatitis was not higher than in the group in which urine bags were used (urine collection kit: 2/68 [3%]; urine bag: 5/68 [7%]; p = 0.44). Novel urine collection kits using filter paper can collect samples from neonates safely and with a high probability of success.

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Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of a Novel Urine Collection Kit Using Filter Paper in Neonates: An Observational Study

Nagano

Imaizumi

et al. 2021

Children

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“…The presence of ≥ 5 white blood cells per high power field in centrifuged urine or ≥ 10 white blood cells as detected by hemocytometer in uncentrifuged urine, respectively, is the gold standard for pyuria [11, 13, 22, 77, 79]. However, pyuria is not diagnostic of UTI [85, 86]. Pyuria has a specificity of approximately 81% and sensitivity of 73% [81].…”

Section: Laboratory Investigationsmentioning

confidence: 99%

“…Sterile pyuria can be associated with infection due to anaerobic bacteria, tuberculosis, viral pathogens, chemical or allergic inflammation, cervical or vaginal secretion, Kawasaki disease, crystalluria, appendicitis, regional enteritis, glomerulonephritis, and interstitial nephritis [6, 11]. Conversely, the absence of pyuria on a single specimen does not rule out UTI [86]. Serial urinalysis in patients with UTI eventually shows pyuria.…”

Section: Laboratory Investigationsmentioning

confidence: 99%

Urinary Tract Infection in Children

Leung

Wong

Leung

et al. 2019

IAD

179

105

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Background: Urinary Tract Infection (UTI) is a common infection in children. Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition. Objective: To provide an update on the evaluation, diagnosis, and treatment of urinary tract infection in children. Methods: A PubMed search was completed in clinical queries using the key terms “urinary tract infection”, "pyelonephritis" OR "cystitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature and the pediatric age group. Patents were searched using the key terms “urinary tract infection” "pyelonephritis" OR "cystitis" from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com. Results: Escherichia coli accounts for 80 to 90% of UTI in children. The symptoms and signs are nonspecific throughout infancy. Unexplained fever is the most common symptom of UTI during the first two years of life. After the second year of life, symptoms and signs of pyelonephritis include fever, chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include suprapubic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children to radiation. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcome. The choice of antibiotics should take into consideration local data on antibiotic resistance patterns. Recent patents related to the management of UTI are discussed. Conclusion: Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI. Parenteral antibiotic therapy is recommended for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication. A combination of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin can be used in those situations. Routine antimicrobial prophylaxis is rarely justified, but continuous antimicrobial prophylaxis should be considered for children with frequent febrile UTI.

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