BACKGROUND: The need for reducing unnecessary antibiotic treatment is being emphasized in the management of urinary tract infections (UTI), a disease frequent in childhood. An ideal test should provide early diagnosis without the waiting times of urine culture, but even a simple test of exclusion could significantly improve patient management. METHODS: We evaluated the sensitivity, specificity, negative and positive predictive value of automated microscopy IRIS iQ200 combined with the dipstick analyses in children with suspected UTI. Multivariable logistic regression analysis was used to identify the set of variables that best predict positive culture results and develop a numerical risk score. RESULTS: Of 474 consecutive urine samples retrospectively analyzed, 69 were positive at urine culture with prevalence of infection of 14.6%. Parameters significantly associated with the presence of infection in multivariable analysis were age <1 year (p<0.001), leukocyte esterase ≥ 15×10^6/L (p<0.001), number of small particles (ASP) ≥ 5500 × 10^6/L (p<0.001) and bacteria ≥ 3 × 10^6/L (p=0.01). The derived score ranged from 0 to 10, with higher values indicating higher risk of UTI. The area under the score ROC curve was 79% (95% CI 0.72-0.85), and was better than those of the individual urinary chemical and microscopic analyses. CONCLUSIONS: This routine method could improve the management of UTI in children by early identifying patients with low probability of infection, for whom antibiotic treatment can be withheld until the results of urine culture become available.
BACKGROUND: The need for reducing unnecessary antibiotic treatment is being emphasized in the management of urinary tract infections (UTI), a disease frequent in childhood. An ideal test should provide early diagnosis without the waiting times of urine culture, but even a simple test of exclusion could significantly improve patient management. METHODS: We evaluated the sensitivity, specificity, negative and positive predictive value of automated microscopy IRIS iQ200 combined with the dipstick analyses in children with suspected UTI. Multivariable logistic regression analysis was used to identify the set of variables that best predict positive culture results and develop a numerical risk score. RESULTS: Of 474 consecutive urine samples retrospectively analyzed, 69 were positive at urine culture with prevalence of infection of 14.6%. Parameters significantly associated with the presence of infection in multivariable analysis were age <1 year (p<0.001), leukocyte esterase ≥ 15×10^6/L (p<0.001), number of small particles (ASP) ≥ 5500 × 10^6/L (p<0.001) and bacteria ≥ 3 × 10^6/L (p=0.01). The derived score ranged from 0 to 10, with higher values indicating higher risk of UTI. The area under the score ROC curve was 79% (95% CI 0.72-0.85), and was better than those of the individual urinary chemical and microscopic analyses. CONCLUSIONS: This routine method could improve the management of UTI in children by early identifying patients with low probability of infection, for whom antibiotic treatment can be withheld until the results of urine culture become available.
Authors: Anne Russcher; Elske Kusters; Ron Wolterbeek; Ed J Kuijper; Christa M Cobbaert; Martha T van der Beek Journal: J Clin Microbiol Date: 2015-10-21 Impact factor: 5.948
Authors: Dimard E Foudraine; Martijn P Bauer; Anne Russcher; Elske Kusters; Christa M Cobbaert; Martha T van der Beek; Janneke E Stalenhoef Journal: J Clin Microbiol Date: 2018-05-25 Impact factor: 5.948
Authors: Liang Dong; Joshua Watson; Sha Cao; Samuel Arregui; Vijay Saxena; John Ketz; Abduselam K Awol; Daniel M Cohen; Jeffrey M Caterino; David S Hains; Andrew L Schwaderer Journal: PLoS One Date: 2020-07-06 Impact factor: 3.240