Development of a Score Based on Urinalysis to Improve the Management of Urinary Tract Infection in Children
American Journal of BioScience
Volume 3, Issue 1, January 2015, Pages: 1-6
Received: Dec. 12, 2014; Accepted: Dec. 23, 2014; Published: Dec. 31, 2014
Views 2367      Downloads 232
Authors
Mohamed Hamed Bahbah, Pediatrics department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
Ahmed Anower Khattab, Pediatrics department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
Rania Salah El Zayat, Pediatrics department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
Abdelwahab Mohamed Badr, Pediatrics department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt; Pediatrics resident, Shebien Elkom Teaching Hospital, Menoufia, Egypt
Article Tools
Follow on us
Abstract
Objectives: Our aim is to develop a score that may help in reducing the misuse of antibiotics in treatment of urinary tract infection before appearance of urine culture. 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 urine analysis, dipstick (leukocyte esterase and nitrite) and bacterial colony count 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 200 children were having symptoms of UTI, 93 child had confirmed UTI with prevalence 46.5%. Parameters significantly associated with the presence of infection in multivariable analysis were age 9-12 years (p < 0.05), leukocyte esterase positive (p < 0.001), nitrite positive (p < 0.05), pus cell >10/HPF (p < 0.05), RBCs>10/HPF (p < 0.05) and bacteria ≥ 10^6 (p < 0.05).The derived score ranged from 1 to 7, with higher values indicating higher risk of UTI. Conclusion: This routine method could improve the management of UTI in children by early identifying patients with low probability of infection, for which antibiotic treatment can be withheld until the results of urine culture become available.
Keywords
Urinary Tract Infection, Urinalysis
To cite this article
Mohamed Hamed Bahbah, Ahmed Anower Khattab, Rania Salah El Zayat, Abdelwahab Mohamed Badr, Development of a Score Based on Urinalysis to Improve the Management of Urinary Tract Infection in Children, American Journal of BioScience. Vol. 3, No. 1, 2015, pp. 1-6. doi: 10.11648/j.ajbio.20150301.11
References
[1]
American Academy of Pediatrics (AAP) (2011): Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics; 61(11):56-98.
[2]
Bauer R, and Kogan BA. (2008): New developments in the diagnosis and management of pediatric ITO. UrolClin North Am; (35): 47 – 85.
[3]
Bhat R.G, Katy T.A. and Place F.C.(2011): Pediatric urinary tract infections.Emerg Med Clin N Am, 29, pp. 637–653.
[4]
Brett White. (2011): Diagnosis and Treatment of Urinary Tract Infections in Children Oregon Health and Science University, Portland, Oregon Am Fam Physician. Feb 15; 83(4):409-415.
[5]
Chernecky CC, Ritchie G, and Berger BJ (2008): Laboratory Tests and diagnostic procedures (5th ed.). Philadelphia, PA: Elsevier Saunders. Clin. Chem: 7(6); 603:12-20.
[6]
Chernecky, Cynthia C, Berger J,et al., (2001):Laboratory Tests and Diagnostic Procedures, 3rd ed. Philadelphia, PA: W. B. Saunders Company. Clin. Chem: 7(5); 211:12-3.
[7]
Heffner, V., Gorelick, M (2008): Pediatric Urinary Tract Infection. ClinPedEmerg Med.; 9: 233-237.
[8]
Henry JB, Davey FR, Herman CJ, et al.,(2001):editors. Basic Laboratory Tests, Mosby Elsevier management by laboratory methods. 20th ed. ;99(8):367-403.
[9]
John, SA. et al., (2006): The use of urinary dipstick test to exclude urinary tract infection: a systematic review of the literature, American Journal of clinical pathology; 126 (3): 428-36.
[10]
Kathy N. Shaw, Karin L. et al., (2001): Screening for urinary tract infection in infants in the emergency department: which test is best. Pediatrics; 101: 1.
[11]
Kenneth B., and Roberts M.D. (2011): Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. PEDIATRICS ;128 – 3
[12]
Mangin D. (2010): Urinary tract infection in primary care. BMJ, 340, p. 657.
[13]
Maria Bitsori and Emmanouil G. (2012): Pediatric Urinary Tract Infections Expert Rev Anti Infect Ther.; 10(10):1153-1164.
[14]
Montini G., Tullus K. and Hewitt I. (2011): Febrile urinary tract infections in children NEJM, 365; 239–250.
[15]
Muoneke V.U., Ibekwe M.U. and Ibekwe R.C. (2012): Annals of Medical and Health Sciences Research, Childhood urinary tract infection in Abakaliki: Etiological organisms and antibiotic sensitivity 2; 1:29-32.
[16]
National Institute for Health and Clinical Excellence (NICE). (2007): Urinary tract infection in children: diagnosis,treatment and long-term management. NICE clinical guideline54. Available: http:// www.nice.org.uk/cg054.
[17]
Pagana KD and Pagana TJ (2010): Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier, 700-701.
[18]
Rosa L., Simone P., Leonardo F., Marta A., Francesca F., Marina C., Emilia M., Francesco E. and Maurizio M. (2011): Development of a score based on urinalysis to improve the management of urinary tract infection in children. ClinicaChimicaActa Volume 413: 3–4, 18 February, 478–482.
[19]
Stanley R, Pagon Z and Bachur R. (2005): Hyperpyrexia among infants younger than 3 months.Pediatric Emergency, 21(5):291-4.
[20]
Tanagho, Emil A., Mcaninch, Jack W., et al., (2004): United States of America: McGraw-Hill companies Inc;. Bacterial Infections of the genitourinary tract p 203-227.
[21]
Williams G.J., Macaskill P., Chan S.F., Turner R.M. , Hodson E. and Craig J.C. (2010): Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis Lancet Infect Dis, 10 , pp. 240–250.
[22]
Yehezkel W., Elisheva Z., Lisa A. and Marc M. (1999):The Validity of the Uriscreen Test for Early Detection of Urinary Tract Infection in ChildrenPEDIATRICS 104 No. 4 October.
[23]
Zorc J.J., Kiddoo D.A. and Shaw K.N. (2005): Diagnosis and management of pediatric urinary tract infectionsClinMicrobiol Rev, 18, 417–422.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186