Does This Child Have a Urinary Tract Infection?

Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 01/2008; 298(24):2895-904. DOI: 10.1001/jama.298.24.2895
Source: PubMed


Urinary tract infection (UTI) is a frequently occurring pediatric illness that, if left untreated, can lead to permanent renal injury. Accordingly, accurate diagnosis of UTI is important.
To review the diagnostic accuracy of symptoms and signs for the diagnosis of UTI in infants and children.
A search of MEDLINE and EMBASE databases was conducted for articles published between 1966 and October 2007, as well as a manual review of bibliographies of all articles meeting inclusion criteria, 1 previously published systematic review, 3 clinical skills textbooks, and 2 experts in the field, yielding 6988 potentially relevant articles.
Studies were included if they contained data on signs or symptoms of UTI in children through age 18 years. Of 337 articles examined, 12 met all inclusion criteria.
Two evaluators independently reviewed, rated, and abstracted data from each article.
In infants with fever, history of a previous UTI (likelihood ratio [LR] range, 2.3-2.9), temperature higher than 40 degrees C (LR range, 3.2-3.3), and suprapubic tenderness (LR, 4.4; 95% confidence interval [CI], 1.6-12.4) were the findings most useful for identifying those with a UTI. Among male infants, lack of circumcision increased the likelihood of a UTI (summary LR, 2.8; 95% CI, 1.9-4.3); and the presence of circumcision was the only finding with an LR of less than 0.5 (summary LR, 0.33; 95% CI, 0.18-0.63). Combinations of findings were more useful than individual findings in identifying infants with a UTI (for temperature >39 degrees C for >48 hours without another potential source for fever on examination, the LR for all findings present was 4.0; 95% CI, 1.2-13.0; and for temperature <39 degrees C with another source for fever, the LR was 0.37; 95% CI, 0.16-0.85). In verbal children, abdominal pain (LR, 6.3; 95% CI, 2.5-16.0), back pain (LR, 3.6; 95% CI, 2.1-6.1), dysuria, frequency, or both (LR range, 2.2-2.8), and new-onset urinary incontinence (LR, 4.6; 95% CI, 2.8-7.6) increased the likelihood of a UTI.
Although individual signs and symptoms were helpful in the diagnosis of a UTI, they were not sufficiently accurate to definitively diagnose UTIs. Combination of findings can identify infants with a low likelihood of a UTI.

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    • "LE , leukocyte esterase . by other studies in the region ( Festo et al . , 2011 ; Musa - Aisien et al . , 2003 ) . Dysuria , haematuria , diarrhea , failure to gain weight and increased frequency of micturition did not show a significant association with occurrence of UTI , in keeping with the non - specific presentation of UTI in young children ( Shaikh et al . , 2007 ; Zorc et al . , 2005 ) Fever of seven days duration or longer in a child should prompt clinicians to consider a diagnosis of UTI and in the presence of a positive urine dipstick results for nitrites and leukocyte esterase , the diagnosis of UTI is highly suggested . Isolated bacteria in this study were predominantly Gram - negative org"
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    ABSTRACT: Urinary tract infection (UTI) is a common cause of fever in children and contributes to morbidity and mortality. This study aimed at determining prevalence, aetiology and antimicrobial susceptibility pattern of the isolates at Muhimbili National Hospital (MNH), Dar es Salaam-Tanzania. Demographic data were collected using a pretested questionnaire. 382 febrile children below five years admitted in the general paediatric wards were recruited. Urine specimens were obtained for urinalysis, culture and antimicrobial sensitivity testing. UTI was detected in 16.8% (64/382). Children who presented prolonged duration of fever (7 days or longer) were more likely to have UTI (p< 0.01). Duration of fever, positive leukocyte and nitrite tests were independent predictors of UTI. Isolated bacteria included Escherichia coli (39.1%), Klebsiella spp (31.2%), Staphylococcus epidermidis (6.2%), Staphylococcus aureus (4.7%) and Pseudomonas aeruginosa (4.7%). We observed high resistance of the isolated uropathogens to ampicillin (79.9%), co-trimoxazole (89%) and clavulanate-amoxillin (70.3%). Amikacin had the least resistance (12.5%) from the isolated pathogens.
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    ABSTRACT: Resumen Se presentan las recomendaciones actualizadas para el manejo diagnóstico y terapéutico de las infecciones del tracto urinario en la infancia. Se revisan las técnicas de recogida de orina más apropiadas en función de la capacidad del niño para controlar la micción y la urgencia del diagnóstico. Se ofrecen directrices para la interpretación de los distintos parámetros del perfil urinario, recomendando sustentar el diagnóstico de infección urinaria en el cultivo de orina. La indicación de ingreso hospitalario o de tratamiento intravenoso en la infección urinaria no depende de la localización de la infección urinaria, sino del grado de repercusión y el riesgo de complicaciones del paciente. Se establecen pautas de tratamiento antibiótico de primera elección y alternativas para su administración parenteral u oral, así como recomendaciones para la elección de la vía, el ritmo y la duración del tratamiento, en función del nivel de riesgo del paciente. No se recomienda la profilaxis rutinaria con antibióticos, tras un primer episodio de infección urinaria, en niños con tracto urinario normal o en niños con reflujo vésico-ureteral de bajo grado; la indicación de profilaxis en pacientes con infecciones recurrentes o con reflujos de alto grado debe ser individualizada. Se recomienda cambiar la actual estrategia de uso rutinario de pruebas de imagen por otra en la que sólo se indiquen de forma individualizada, considerando el nivel de riesgo de cada paciente.
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