Dipstick Screening for Urinary Tract Infection in Febrile Infants

作者：Glissmeyer Eric W^*; Korgenski E Kent; Wilkes Jacob; Schunk Jeff E; Sheng Xiaoming; Blaschke Anne J; Byington Carrie L

来源：Pediatrics, 2014, 133(5): E1121-E1127.

DOI：10.1542/peds.2013-3291

• urinary tract infection
• urinalysis
• infant
• newborn
• predictive value of tests
• reagent strips
• nitrites
• leukocyte esterase
• utilization

OBJECTIVE:This study compares the performance of urine dipstick alone with urine microscopy and with both tests combined as a screen for urinary tract infection (UTI) in febrile infants aged 1 to 90 days.METHODS:We queried the Intermountain Healthcare data warehouse to identify febrile infants with urine dipstick, microscopy, and culture performed between 2004 and 2011. UTI was defined as >50000 colony-forming units per milliliter of a urinary pathogen. We compared the performance of urine dipstick with unstained microscopy or both tests combined (combined urinalysis) to identify UTI in infants aged 1 to 90 days.RESULTS:Of 13030 febrile infants identified, 6394 (49%) had all tests performed and were included in the analysis. Of these, 770 (12%) had UTI. Urine culture results were positive within 24 hours in 83% of UTIs. The negative predictive value (NPV) was >98% for all tests. The combined urinalysis NPV was 99.2% (95% confidence interval: 99.1%-99.3%) and was significantly greater than the dipstick NPV of 98.7% (98.6%-98.8%). The dipstick positive predictive value was significantly greater than combined urinalysis (66.8% [66.2%-67.4%] vs 51.2% [50.6%-51.8%]). These data suggest 8 febrile infants would be predicted to have a false-positive combined urinalysis for every 1 infant with UTI initially missed by dipstick screening.CONCLUSIONS:Urine dipstick testing compares favorably with both microscopy and combined urinalysis in febrile infants aged 1 to 90 days. The urine dipstick test may be an adequate stand-alone screen for UTI in febrile infants while awaiting urine culture results.

• 出版日期2014-5