8
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Using urine nitrite sticks to test for urinary tract infection in children aged < 2 years: a meta-analysis

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          This study aimed to determine whether nitrite sticks are as sensitive at detecting urinary tract infection (UTI) in children <2 years as they are in older children.

          Methods

          I reanalysed data on using nitrite sticks to detect UTIs for children aged either < 2 or 2–18 years. For sensitivity, evidence of a UTI was defined as level 1 when a single uropathogen grew ≥ 10 5 colony forming units/ml (cfu/ml) in two urine samples, level 2 when just one sample was cultured or a threshold of < 10 5 cfu/ml was used, and level 3 if mixed growths or Staphylococcus albus was considered to be positive. For specificity, children were defined as uninfected if they had 1 sterile urine culture. I also reanalysed our previously published data by age.

          Results

          The sensitivity was lower for children aged < 2 years (11 studies, 1321 subjects) than for older children (9 studies, 295 subjects), whether the level-1 values or all the studies were analysed (Fisher’s exact test, p < 0.0001 for both). The level-1 sensitivities were 0.23 in the infants and 0.81 among older children (odds ratio = 0.07, 95% confidence interval 0.03–0.18). The specificity was very high in infants (10 studies, 1783 cases) and older children (7 studies, 5952 cases), at 0.990 and 0.996.

          Conclusions

          Nitrite sticks only have a 23% sensitivity in children aged < 2 years, so cannot reliably rule out UTIs. A positive nitrite stick test is about 99% likely to indicate a UTI in children of any age.

          Related collections

          Most cited references32

          • Record: found
          • Abstract: found
          • Article: not found

          Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring.

          This study evaluated the controversial relationship between the duration of fever before treatment initiation (FBT) for a febrile urinary tract infection (UTI), with renal scarring based on dimercaptosuccinic acid scintigraphy (DMSA) findings.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Diagnostic Accuracy of the Urinalysis for Urinary Tract Infection in Infants <3 Months of Age

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              New renal scarring in children who at age 3 and 4 years had had normal scans with dimercaptosuccinic acid: follow up study.

              To determine up to what age children remain at risk of developing a new renal scar from a urinary tract infection. Follow up study. Families of children who had normal ultrasound scans and scanning with dimercaptosuccinic acid (DMSA) after referral with a urinary tract infection when aged 3 (209) or 4 (220) were invited to bring the children for repeat scans 2-11 years later. A history of infections since the original scan was obtained for children not having a repeat scan. Teaching hospital. Children from three health districts in whom a normal scan had been obtained at age 3-4 years in 1985-1992 because of a urinary tract infection. Frequency of new renal scars in each age group. In each group, about 97% of children either had repeat scanning (over 80%) or were confidently believed by their general practitioner or parent not to have had another urinary infection. The rate of further infections since the original scan was similar in the 3 and 4 year old groups (48/176 (27%)) and 55/179 (31%)). Few children in either group known to have had further urinary infections did not have repeat scanning (3/209 (1.4%) and 4/220 (1.8%)). In the 3 year old group, 2.4% (5/209) had one or more new kidney scars at repeat scanning (one sided 95% confidence interval up to 5.0%), whereas none of the 4 year olds did (one sided 95% confidence interval up to 1.4%). The children who developed scars were all aged under 3.4 years when scanned originally. Children with a urinary tract infection but unscarred kidneys after the third birthday have about a 1 in 40 risk of developing a scar subsequently, but after the fourth birthday the risk is either very low or zero. Thus the need for urinary surveillance is much reduced in a large number of children.
                Bookmark

                Author and article information

                Contributors
                malcolm.coulthard@nuth.nhs.uk
                Journal
                Pediatr Nephrol
                Pediatr. Nephrol
                Pediatric Nephrology (Berlin, Germany)
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0931-041X
                1432-198X
                20 March 2019
                20 March 2019
                2019
                : 34
                : 7
                : 1283-1288
                Affiliations
                ISNI 0000 0004 4904 7256, GRID grid.459561.a, Great North Children’s Hospital, ; Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
                Author information
                http://orcid.org/0000-0001-8316-8957
                Article
                4226
                10.1007/s00467-019-04226-6
                6531406
                30895368
                bd1e9ac7-14be-4c0c-baad-353d4249f00d
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 12 January 2019
                : 24 February 2019
                : 27 February 2019
                Funding
                Funded by: Newcastle University
                Categories
                Original Article
                Custom metadata
                © IPNA 2019

                Nephrology
                child,urinary tract infection,urine,culture,bacteria,diagnosis,nitrite,stick testing
                Nephrology
                child, urinary tract infection, urine, culture, bacteria, diagnosis, nitrite, stick testing

                Comments

                Comment on this article