Showing posts with label UTI. Show all posts
Showing posts with label UTI. Show all posts

Friday, May 29, 2015

Taking a Peek at the Accuracy of the Urinalysis for Diagnosing UTIs in Infants

By: Lewis First, MD, MS; Editor-in-Chief       

      The gold standard for diagnosis of a urinary tract infection (UTI) is the urine culture, but just how accurate is the urinalysis itself, especially in young infants?  Schroeder et al. (doi:10.1542/peds.2015-0012) tackled this question through a cross-sectional look at a cohort of 276 infants under three months of age who had a documented UTI based on a urine culture.  The authors then looked at the sensitivity and specificity of the urinalysis findings for infection.    
     More specifically, the authors report on the sensitivity of leukocyte esterase (LE) and of pyuria in the urines studied and the results may surprise you in terms of the accuracy achieved just with the urinalysis.   
     To add more import to this study, we asked Dr. Ken Roberts who chaired the AAP committee that produced the recently revised UTI guidelines to add his perspective on the findings with a commentary (doi:10.1542/peds.2015-0884) also being released this week.  
      If you wonder whether to use the urinalysis findings to help decide whether or not to get a urine culture, go with the flow and read both this study and commentary and see if you want to pay even more attention to the urinalysis results as a diagnostic indicator. 

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Tuesday, April 29, 2014

How Good Is a Dipstick Vs. Urine Microscopy to Screen for UTI?

Have you ever been told that a urine dipstick alone may not be a good enough marker for predicting a UTI in a febrile infant—and that urine microscopy was needed as well to support the diagnosis pending culture?

Public Domain via the National Cancer Institute
Glissmeyer et al. (doi: 10.1542/peds. 2013-3291) used the large Intermountain Healthcare database involving more than 13,000 febrile infants to determine the ability of urine dipstick testing by itself when compared with microscopy or a combination of the two to screen for possible UTI. The results will surprise you and may even change the way you practice.

Take a peek at this study and let us know your thoughts. Would you use the dipstick findings alone or still rely on microscopy to convince you to treat for a presumptive UTI? Let us know by responding to this blog, sharing your thoughts via an eLetter, or on Facebook or Twitter.

Related Reading:

Tuesday, March 25, 2014

Siblings of Children with Vesicoureteral Reflux: Who Needs a Reflux Workup?

Grade III Vesicoureteral Reflux.
Photo by radswiki via Wikimedia Commons
There are certainly benefits and risks to screening siblings of children with vesicoureteral reflux (VUR) and trying to better define just which siblings we should be screening is information that could be quite useful to have on hand.

Fortunately Hunziker et al. (doi: 10.1542/peds.2013-3498) sought such information by gaining
permission to screen children less than 6 years of age for VUR whose sibling had a documented UTI, dividing these children into those who had had a UTI and those who did not.

The authors provide quite the flow of results and help us better define just what might make us even more eager to screen a sibling for reflux. If you take a peek at this study, you’ll learn just which siblings might be most apt to benefit from the VUR workup when an index case appears in the same family.

Related Reading: