ESPN 53rd Annual Meeting

ESPN 2021


 
Diagnostic performance of urine diagnostics in children with a suspected urinary tract infection
STEPHANIE MIDDELKOOP 1 JANNEKE LUDWIG-ROUKEMA 2 VALENTINA GRACCHI 2 ELIZABETH LEGGER 3 NATALIYA HILT 4 JOOST VAN PELT 5 COEN STEGEMAN 1 MARTINE BESOUW 2

1- UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN, DEPARTMENT OF INTERNAL MEDICINE, DIVISION OF NEPHROLOGY, GRONINGEN, THE NETHERLANDS
2- UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN, DEPARTMENT OF PEDIATRIC NEPHROLOGY, GRONINGEN, THE NETHERLANDS
3- UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN, DEPARTMENT OF PEDIATRIC INFECTIOUS DISEASES, RHEUMATOLOGY AND IMMUNOLOGY, GRONINGEN, THE NETHERLANDS
4- UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN, DEPARTMENT OF MEDICAL MICROBIOLOGY AND INFECTION PREVENTION, GRONINGEN, THE NETHERLANDS
5- UNIVERSITY OF GRONINGEN, UNIVERSITY MEDICAL CENTER GRONINGEN, DEPARTMENT OF LABORATORY MEDICINE, GRONINGEN, THE NETHERLANDS
 
Introduction:

The diagnosis of urinary tract infection (UTI) can be challenging in children. Many studies are based on laboratory results alone and exclude patients with underlying urological abnormalities, hence they do not represent general practice. We investigated the performance of UTI screening methods in a broad pediatric population.

Material and methods:

A 3 year period cohort study in children with suspected UTI, in whom urine dipstick, automated urinalysis (UF-1000i) and urine culture was performed. Diagnostic performance was assessed for the total population and separately for children <3 months (group 1), ≥3 months without clean intermittent self-catheterisation (CIC) (group 2), ≥3 months with CIC (group 3). Diagnosis of UTI was based on urine culture, symptomatology and the conclusion of the treating physician.

Results:

292 periods were included, UTI was diagnosed in 74 (25.3%), including 6/50 (12.0%) in group 1, 56/211 (26.5%) in group 2 and 12/31 (38.7%) in group 3. Dipstick: sensitivity and specificity for leucocyte esterase 3+ was 64.9% and 83.0% for all children, 66.7% and 88.6% in group 1, 60.7% and 85.2% in group 2, and 83.3% and 52.6% in group 3. For nitrite it was 33.8% and 91.7% for all children, 16.7% and 100% in group 1, 39.3% and 91.6% in group 2, and 16.7% and 73.7% in group 3. Automated urinalysis: at 90% sensitivity, the leucocyte cut-off was 13/µL for all children (specificity 22.9%), 15/µL in group 2 (specificity 27.1%), and 70/µL in group 3 (specificity 36.8%). Bacterial count cut-off was 63/µL for all children (specificity 62.4%), 98/µL in group 2 (specificity 65.2%), and 54/µL in group 3 (specificity 36.8%). Cut-off values could not be determined for group 1.

Conclusions:

Diagnostic performance of urinary screening parameters in children is moderate, especially <3 months, emphasizing the need to incorporate clinical presentation when diagnosing UTI. Specific cut-off values for children with CIC could be useful.