Urinary tract infections (UTIs) represent a significant cause of serious bacterial infection in the pediatric population. Recently there has been much discussion surrounding the screening and diagnosis of UTIs. The American Academy of Pediatrics 2011 guidelines1 recommend suprapubic aspiration or catheterization in patients who cannot spontaneously void. Lavelle et al2 recently proposed a 2-step approach for the diagnosis of UTIs to reduce the number of catheterizations due to their invasiveness. The study suggests initially screening for leukocyte esterase and nitrates with a bagged sample before catheterization for culture.
However, a negative nitrite has little value in ruling out UTIs.1 Similarly, the sensitivity of leukocyte esterase has been cited as ∼79%,3 which is far from perfect for a screening test. In addition, a recent study by Shaikh et al4 found that children with UTIs caused by certain uropathogens other than Escherichia coli were less likely to have a positive leukocyte esterase test.
Because of the relatively low sensitivity of the dipstick test, a urine culture would not have been performed on many children with a true UTI. The fact that patients did not follow-up at The Children’s Hospital of Philadelphia network facilities with persistent symptoms is not convincing evidence that UTIs were not missed; children could have presented to out-of-network practices or symptoms may have resolved spontaneously. Accordingly, based on the well-established low sensitivity of the leukocyte esterase and nitrite tests, we fear the 2-step method proposed by Lavelle et al2 may result in more missed cases of UTI. Therefore, to allow us to perform both a bedside test (either dipstick or urinalysis) and a urine culture, in our practices, we will continue to perform catheterizations in young children in whom we suspect UTI.
Conflict of Interest: None declared.
- Roberts KB
- Lavelle JM,
- Blackstone MM,
- Funari MK, et al
- Shaikh N,
- Shope TR,
- Hoberman A,
- Vigliotti A,
- Kurs-Lasky M,
- Martin JM
- Copyright © 2017 by the American Academy of Pediatrics