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Wilson LM, Tam C, Wai Lai VK, Ajayi M, Lê ML, Oketola B, Klassen TP, Aregbesola A. Practice variation in urine collection methods among pre-toilet trained children with suspected urinary tract infection: a systematic review. BMC Pediatr 2024; 24:294. [PMID: 38698354 PMCID: PMC11067245 DOI: 10.1186/s12887-024-04751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are a common cause of acute illness among infants and young children. There are numerous methods for collecting urine in children who are not toilet trained. This review examined practice variation in the urine collection methods for diagnosing UTI in non-toilet-trained children. METHODS A systematic review was completed by searching MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), PsycInfo (Ovid), CINAHL (EBSCO), and JBI (Ovid) from January 1, 2000 until October 9, 2021 and updated on May 24, 2023. Studies were included if they were conducted in an acute care facility, examined pre-toilet trained children, and compared one urine collection method with another for relevant health care outcomes (such as length of stay in an ED, or re-visits or readmissions to the ED) or provider satisfaction. Two independent reviewers screened the identified articles independently, and those included in the final analysis were assessed for quality and bias using the Newcastle-Ottawa Scale. RESULTS Overall, 2535 articles were reviewed and 8 studies with a total of 728 children were included in the final analysis. Seven studies investigated the primary outcome of interest, practice variation in urine collection methods to diagnose a UTI. The seven studies that investigated novel methods of urine collection concluded that there were improved health care outcomes compared to conventional methods. Novel methods include emerging methods that are not captured yet captured in clinical practice guidelines including the use of ultrasound guidance to aid existing techniques. Three studies which investigated healthcare provider satisfaction found preference to novel methods of urine collection. CONCLUSIONS There is significant practice variation in the urine collection methods within and between countries. Further research is needed to better examine practice variation among clinicians and adherence to national organizations and societies guidelines. PROSPERO registration number CRD42021267754.
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Affiliation(s)
- Lucy M Wilson
- Children's Hospital Research Institute of Manitoba, University of Manitoba, 715 McDermot Ave., Winnipeg, MB, R3E 3P4, Canada
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Clara Tam
- Children's Hospital Research Institute of Manitoba, University of Manitoba, 715 McDermot Ave., Winnipeg, MB, R3E 3P4, Canada
| | - Veronica Ka Wai Lai
- Children's Hospital Research Institute of Manitoba, University of Manitoba, 715 McDermot Ave., Winnipeg, MB, R3E 3P4, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Motunrayo Ajayi
- Children's Hospital Research Institute of Manitoba, University of Manitoba, 715 McDermot Ave., Winnipeg, MB, R3E 3P4, Canada
| | - Mê-Linh Lê
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada
| | - Banke Oketola
- Children's Hospital Research Institute of Manitoba, University of Manitoba, 715 McDermot Ave., Winnipeg, MB, R3E 3P4, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, 715 McDermot Ave., Winnipeg, MB, R3E 3P4, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Alex Aregbesola
- Children's Hospital Research Institute of Manitoba, University of Manitoba, 715 McDermot Ave., Winnipeg, MB, R3E 3P4, Canada.
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
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Hari P, Meena J, Kumar M, Sinha A, Thergaonkar RW, Iyengar A, Khandelwal P, Ekambaram S, Pais P, Sharma J, Kanitkar M, Bagga A. Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux. Pediatr Nephrol 2024; 39:1639-1668. [PMID: 37897526 DOI: 10.1007/s00467-023-06173-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/27/2023] [Accepted: 09/17/2023] [Indexed: 10/30/2023]
Abstract
We present updated, evidence-based clinical practice guidelines from the Indian Society of Pediatric Nephrology (ISPN) for the management of urinary tract infection (UTI) and primary vesicoureteric reflux (VUR) in children. These guidelines conform to international standards; Institute of Medicine and AGREE checklists were used to ensure transparency, rigor, and thoroughness in the guideline development. In view of the robust methodology, these guidelines are applicable globally for the management of UTI and VUR. Seventeen recommendations and 18 clinical practice points have been formulated. Some of the key recommendations and practice points are as follows. Urine culture with > 104 colony forming units/mL is considered significant for the diagnosis of UTI in an infant if the clinical suspicion is strong. Urine leukocyte esterase and nitrite can be used as an alternative screening test to urine microscopy in a child with suspected UTI. Acute pyelonephritis can be treated with oral antibiotics in a non-toxic infant for 7-10 days. An acute-phase DMSA scan is not recommended in the evaluation of UTI. Micturating cystourethrography (MCU) is indicated in children with recurrent UTI, abnormal kidney ultrasound, and in patients below 2 years of age with non-E. coli UTI. Dimercaptosuccinic acid scan (DMSA scan) is indicated only in children with recurrent UTI and high-grade (3-5) VUR. Antibiotic prophylaxis is not indicated in children with a normal urinary tract after UTI. Prophylaxis is recommended to prevent UTI in children with bladder bowel dysfunction (BBD) and those with high-grade VUR. In children with VUR, prophylaxis should be stopped if the child is toilet trained, free of BBD, and has not had a UTI in the last 1 year. Surgical intervention in high-grade VUR can be considered for parental preference over antibiotic prophylaxis or in children developing recurrent breakthrough febrile UTIs on antibiotic prophylaxis.
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Affiliation(s)
- Pankaj Hari
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Jitendra Meena
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manish Kumar
- Department of Pediatrics, Chacha Nehru Bal Chikitsalya, New Delhi, India
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Arpana Iyengar
- Department of Pediatric Nephrology, St. Johns Medical College and Hospital, Bengaluru, India
| | - Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sudha Ekambaram
- Department of Pediatric Nephrology, Apollo Children's Hospital, Chennai, India
| | - Priya Pais
- Department of Pediatric Nephrology, St. Johns Medical College and Hospital, Bengaluru, India
| | - Jyoti Sharma
- Department of Pediatrics, KEM Hospital, Pune, India
| | | | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Orfanos I. Decreased incidence of urinary tract infections in febrile infants aged ≤60 days during COVID-19 pandemic. Acta Paediatr 2024. [PMID: 38676461 DOI: 10.1111/apa.17256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
AIM To investigate the incidence rate of urinary tract infections (UTIs) among febrile infants aged ≤60 days before, during, and after the COVID-19 pandemic. METHODS We conducted a retrospective study in 2 Swedish paediatric emergency departments between 2014 and 2022. We included full-term infants aged ≤60 days with fever without source. We calculated the annual incidence rate of UTI per 1000 births. RESULTS We included 1589 full-term infants with fever without source. In 2020, 89 infants were evaluated in the emergency department versus 203-259 in 2017-2019. In 2020, the incidence rate of UTI was 1.43 per 1000 births/year versus 2.18-2.37 in 2017-2019. The median age, sex, fever duration, and urine testing were similar between the years 2017 and 2020. CONCLUSION The number of febrile infants who presented to the paediatric emergency department and the incidence rate of UTIs decreased in 2020. This decrease might imply a systematic misdiagnosis of UTIs in infants with febrile viral infections. A more selective urine testing approach for febrile, previously healthy, infants should be considered to mitigate UTI misdiagnosis and its potential harmful effects.
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Affiliation(s)
- Ioannis Orfanos
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatrics, Skåne University Hospital, Lund University, Lund, Sweden
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Jaswon MS. For Whom the bugs toll: do uTLR4 levels have a role in screening for urinary tract infection? Pediatr Nephrol 2024; 39:345-346. [PMID: 37768418 DOI: 10.1007/s00467-023-06171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Mervyn S Jaswon
- Department of Paediatrics, Whittington Hospital, London, UK.
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
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Klaus R, Barth TK, Imhof A, Thalmeier F, Lange-Sperandio B. Comparison of clean catch and bag urine using LC-MS/MS proteomics in infants. Pediatr Nephrol 2024; 39:203-212. [PMID: 37523035 PMCID: PMC10673958 DOI: 10.1007/s00467-023-06098-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Urinary proteomics identifies the totality of urinary proteins and can therefore help in getting an early and precise diagnosis of various pathological processes in the kidneys. In infants, non-invasive urine collection is most commonly accomplished with a urine bag or clean catch. The influence of those two collection methods on urinary proteomics was assessed in this study. METHODS Thirty-two urine samples were collected in infants using urine bag and clean catch within 24 h. Nine boys and seven girls with a mean age of 4.3 ± 2.9 months were included (5 × post-pyelonephritis, 10 × non-kidney disease, 1 × chronic kidney disease (CKD)). Liquid chromatography-mass spectrometry (LC-MS/MS) was performed in data-independent acquisition (DIA) mode. Protein identification and quantification were achieved using Spectronaut. RESULTS A total of 1454 urinary proteins were detected. Albumin and α-1-microglobulin were detected the most. The 18 top-abundant proteins accounted for 50% of total abundance. The number of proteins was slightly, but insignificantly higher in clean catch (957 ± 245) than in bag urine (876 ± 255). The median intensity was 1.2 × higher in the clean catch. Overall, differential detection of proteins was 29% between the collection methods; however, it diminished to 3% in the 96 top-abundant proteins. Pearson's correlation coefficient was 0.81 ± 0.11, demonstrating a high intraindividual correlation. A principal component analysis and a heat map showed clustering according to diagnoses and patients rather than to the collection method. CONCLUSION Urinary proteomics shows a high correlation with minor variation in low-abundant proteins between the two urine collection methods. The biological characteristics overrule this variation. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Richard Klaus
- Division of Pediatric Nephrology, Department of Pediatrics, Dr. V. Hauner Children's Hospital, Ludwig-Maximilians University, Lindwurmstraße 4, 80337, Munich, Germany
| | - Teresa K Barth
- Faculty of Medicine, Biomedical Center, Protein Analysis Unit, Ludwig-Maximilians University, Planegg-Martinsried, Munich, Germany
| | - Axel Imhof
- Faculty of Medicine, Biomedical Center, Protein Analysis Unit, Ludwig-Maximilians University, Planegg-Martinsried, Munich, Germany
| | - Franziska Thalmeier
- Division of Pediatric Nephrology, Department of Pediatrics, Dr. V. Hauner Children's Hospital, Ludwig-Maximilians University, Lindwurmstraße 4, 80337, Munich, Germany
| | - Bärbel Lange-Sperandio
- Division of Pediatric Nephrology, Department of Pediatrics, Dr. V. Hauner Children's Hospital, Ludwig-Maximilians University, Lindwurmstraße 4, 80337, Munich, Germany.
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Svingel LS, Christiansen CF, Birn H, Søgaard KK, Nørgaard M. Temporal changes in incidence of hospital-diagnosed acute pyelonephritis: A 19-year population-based Danish cohort study. IJID REGIONS 2023; 9:104-110. [PMID: 38020186 PMCID: PMC10656209 DOI: 10.1016/j.ijregi.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023]
Abstract
Objectives To examine temporal changes in the incidence of hospital-diagnosed acute pyelonephritis (APN) and characterize associated demographics. Methods Cohort study including Danish patients with hospital-diagnosed APN during 2000-2018, identified by International Classification of Diseases, 10th Revision codes. Annual sex- and age-standardized incidence rates per 10,000 person years with 95% confidence intervals (CIs) were stratified by sex, age group, diagnosis code, and region of residence. Incidence rates for selected urinary tract infections and sepsis diagnoses were also computed. Results We included 66,937 hospital-diagnosed APN episodes in 57,162 patients. From 2000 to 2018, the incidence increased from 6.8 (95% CI: 6.8-6.8) to 15.4 (95% CI: 15.4-15.4) in women and from 2.7 (95% CI: 2.7-2.7) to 4.5 (95% CI: 4.5-4.5) in men. Among infants, the rate rose from 7.4 (95% CI: 7.4-7.4) to 64.8 (95% CI: 64.7-64.9) in girls and from 17.1 (95% CI: 17.1-17.2) to 52.5 (95% CI: 52.4-52.6) in boys. Concomitant declines were observed in incidences of hospital-diagnosed unspecified urinary tract infections and sepsis. Conclusion The APN incidence roughly doubled during 2000-2018. The increase was largely driven by a prominently increasing incidence among young children which was not explained by the enlarging prevalence of congenital anomalies of the kidney and urinary tract.
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Affiliation(s)
- Lise Skovgaard Svingel
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Henrik Birn
- Departments of Clinical Medicine and Renal Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Kirstine Kobberøe Søgaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Wald ER, Eickhoff JC. Determining the Best Definition for a Positive Urine Culture in Young Children. Pediatrics 2023; 152:e2023062883. [PMID: 37691605 DOI: 10.1542/peds.2023-062883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Ellen R Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, American Family Children's Hospital, Madison, Wisconsin
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Karageorgos S, Hibberd O, Mullally PJW, Segura-Retana R, Soyer S, Hall D. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. Antibiotics (Basel) 2023; 12:1092. [PMID: 37508188 PMCID: PMC10376281 DOI: 10.3390/antibiotics12071092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Antibiotics are one of the most prescribed medications in pediatric emergency departments. Antimicrobial stewardship programs assist in the reduction of antibiotic use in pediatric patients. However, the establishment of antimicrobial stewardship programs in pediatric EDs remains challenging. Recent studies provide evidence that common infectious diseases treated in the pediatric ED, including acute otitis media, tonsillitis, community-acquired pneumonia, preseptal cellulitis, and urinary-tract infections, can be treated with shorter antibiotic courses. Moreover, there is still controversy regarding the actual need for antibiotic treatment and the optimal dosing scheme for each infection.
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Affiliation(s)
- Spyridon Karageorgos
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
- First Department of Pediatrics, Aghia Sophia Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Owen Hibberd
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Patrick Joseph William Mullally
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
- Department of Medicine, Cardiff University, Cardiff CF10 3AT, UK
| | - Roberto Segura-Retana
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
- Pediatric Emergency Department, Hospital Nacional de Niños, San José 0221, Costa Rica
| | - Shenelle Soyer
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
| | - Dani Hall
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
- Department of Emergency Medicine, Children’s Health Ireland at Crumlin, D12 N512 Dublin, Ireland
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9
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Herreros ML, Barrios A, Sánchez A, Del Valle R, Pacheco M, Gili P. Urine collection methods in precontinent children treated at the paediatric emergency department. Acta Paediatr 2023; 112:550-556. [PMID: 36463432 DOI: 10.1111/apa.16614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/05/2022]
Abstract
AIM To describe the urine collection methods used in precontinent children presenting at the Paediatric Emergency Department (PED) and compare results and contamination rates. METHODS Retrospective observational cohort study that included 1678 urine cultures collected in infants <24 months of age between January 2016 and December 2019. Urine cultures were compared based on collection technique, sex and patient age. RESULTS In total, 60.4% of samples were collected by clean-catch urine collection (CCUC), 26.4% by urethral catheterisation (UC) and 13.2% by urine bag (UB). Contamination rates were 2.9% (95% CI 1.3, 4.4) for UC, 11.3% (95% CI 9.3, 13.2) for CCUC and 23.4% (95% CI 17.8, 29.0) for UB. Significant differences in contamination rates were found between UC and CCUC in the 6-12-month age group (1.9% [95% CI 0.0-4.0] versus 12.0% [95% CI 7.2-16.8] [p < 0.0009]), and between UC and UB for all ages. CONCLUSIONS CCUC is the most common method for urine culture collection in infants <24 months of age at the PED in our centre. UC has the lowest contamination rates, but significant differences were only observed between CCUC and UC in the 6-12-month age group. CCUC is a non-invasive alternative for urine collection in infants.
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Affiliation(s)
- María Luisa Herreros
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Ana Barrios
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Aida Sánchez
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Rut Del Valle
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Mónica Pacheco
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Pablo Gili
- Hospital Universitario Fundación Alcorcón, Alcorcon, Spain
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Urinary HSP70 improves diagnostic accuracy for urinary tract infection in children: UTILISE study. Pediatr Nephrol 2023; 38:791-799. [PMID: 35849222 DOI: 10.1007/s00467-022-05664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The accuracy of conventional urinalysis in diagnosing urinary tract infection (UTI) in children is limited, leading to unnecessary antibiotic exposure in a large fraction of patients. Urinary heat shock protein 70 (uHSP70) is a novel marker of acute urinary tract inflammation. We explored the added value of uHSP70 in discriminating UTI from other infections and conditions confused with UTI. METHODS A total of 802 children from 37 pediatric centers in seven countries participated in the study. Patients diagnosed with UTI (n = 191), non-UTI infections (n = 178), contaminated urine samples (n = 50), asymptomatic bacteriuria (n = 26), and healthy controls (n = 75) were enrolled. Urine and serum levels of HSP70 were measured at presentation in all patients and after resolution of the infection in patients with confirmed UTI. RESULTS Urinary (u)HSP70 was selectively elevated in children with UTI as compared to all other conditions (p < 0.0001). uHSP70 predicted UTI with 89% sensitivity and 82% specificity (AUC = 0.934). Among the 265 patients with suspected UTI, the uHSP70 > 48 ng/mL criterion identified the 172 children with subsequently confirmed UTI with 90% sensitivity and 82% specificity (AUC = 0.862), exceeding the individual diagnostic accuracy of leukocyturia, nitrite, and leukocyte esterase positivity. uHSP70 had completely normalized by the end of antibiotic therapy in the UTI patients. Serum HSP70 was not predictive. CONCLUSIONS Urine HSP70 is a novel non-invasive marker of UTI that improves the diagnostic accuracy of conventional urinalysis. We estimate that rapid urine HSP70 screening could spare empiric antibiotic administration in up to 80% of children with suspected UTI. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Rodríguez-González M, Castellano-Martínez A, Estalella-Mendoza A, Rodríguez-Campoy P, Estepa-Pedregosa L, Calero-Ruiz MM, Sáez-Benito Godino A, Flores-González JC. Correlation between urinary and serum NT-proBNP in acute bronchiolitis: A pilot study. Pediatr Pulmonol 2023; 58:492-499. [PMID: 36314349 DOI: 10.1002/ppul.26215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/25/2022] [Accepted: 10/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIMS We aimed to analyze the correlation of urinary with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and its association with severity in acute bronchiolitis. MATERIAL AND METHODS A pilot observational study was conducted between October 1, 2021 and March 31, 2022 including acute bronchiolitis cases who attended our institution. Serum and urinary NT-proBNP concentrations were determined using the Alere i NT-proBNP assay in time-matched urine and blood samples. The Mann-Whitney U test, Spearman's correlations, and simple linear regression were utilized to analyze the association of urine NT-proBNP levels with serum NT-proBNP and with variables indicative of severe bronchiolitis. RESULTS Seventeen infants (median age 68 [IQR: 36-91] days) with 36 time-matched samples were included. The urine NT-proBNP was positively and strongly correlated with the serum NT-proBNP concentrations (Spearman's ρ = 0.81 & R2 coefficient = 0.751; p < 0.001), and increased with higher C-reactive protein, (p = 0.004), procalcitonin (p = 0.001), and pCO2 (p = 0.029) levels. The initial urinary NT-proBNP concentrations were higher in those infants that required ventilatory support compared with those without this outcome (1.85 [IQR: 1.16-2.44] vs. 0.63 [IQR: 0.45-0.84] pg/mg); p < 0.001); and resulted positively and strongly correlated with the duration of the ventilatory support (Spearman's ρ = 0.76; p < 0.001) and the length of stay hospitalization (Spearman's ρ = 0.84; p < 0.001). CONCLUSION The urinary NT-proBNP concentrations could be a reliable surrogate for serum NT-proBNP levels and resulted elevated in cases of acute bronchiolitis with complicated evolution, suggesting a potential as a noninvasive tool to assess severity in this setting.
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Affiliation(s)
- Moises Rodríguez-González
- Pediatric Cardiology Division, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - Ana Castellano-Martínez
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Pediatric Nephrology Division, Puerta del Mar University Hospital, Cádiz, Spain
| | - Ana Estalella-Mendoza
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Patricia Rodríguez-Campoy
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Lorena Estepa-Pedregosa
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - María Mercedes Calero-Ruiz
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Clinical Laboratory Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Ana Sáez-Benito Godino
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Clinical Laboratory Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Jose Carlos Flores-González
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
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Brandström P, Hansson S. Urinary Tract Infection in Children. Pediatr Clin North Am 2022; 69:1099-1114. [PMID: 36880924 DOI: 10.1016/j.pcl.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptoms of urinary tract infection (UTI) in young children are nonspecific and urine sampling is challenging. A safe and rapid diagnosis of UTI can be achieved with new biomarkers and culture of clean-catch urine, reserving catheterization or suprapubic aspiration for severely ill infants. Most guidelines recommend ultrasound assessment and use of risk factors to direct further management of children at risk of kidney deterioration. The increasing knowledge of the innate immune system will add new predictors and treatment strategies to the management of UTI in children. Long-term outcome is good for the majority, but individuals with severe scarring can develop hypertension and decline in kidney function.
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Affiliation(s)
- Per Brandström
- Department of Pediatrics, Clinical Science Institute, Sahlgrenska Academy, University of Gothenburg, Gothenburg 416 85, Sweden; Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg 416 85, Sweden.
| | - Sverker Hansson
- Department of Pediatrics, Clinical Science Institute, Sahlgrenska Academy, University of Gothenburg, Gothenburg 416 85, Sweden; Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg 416 85, Sweden
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Boon HA, Lenaerts W, Van Aerde C, Verbakel JY. Outpatient urine collection methods for paediatric urinary tract infections: Systematic review of diagnostic accuracy studies. Acta Paediatr 2021; 110:3170-3179. [PMID: 34236715 DOI: 10.1111/apa.16027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
AIM To investigate the diagnostic test accuracy of urine collection methods for urinary tract infections in outpatient children. METHODS A systematic literature review until April 2021 (Medline, Web of Science, Embase, Cinahl) to examine the diagnostic test accuracy of urine culture on collection methods for urinary tract infection in outpatient children below 18 years. Contamination rates were studied as secondary outcome. The risk of bias was assessed using the QUADAS-2 criteria. Two-by-two tables were extracted in duplicate to calculate sensitivities, specificities, and likelihood ratios with 95% confidence intervals. RESULTS The search identified seven relevant studies. Clean catch compared to catheterization in children less than 90 days showed a sensitivity and specificity of 97% and 89% (95% CI: 84%-100% and 67%-99%), respectively. Adhesive bags compared to catheterization showed a sensitivity of 83% (95% CI: 75%-90%) and specificity of 91% (95% CI: 83%-96%). There was a similar diagnostic accuracy when comparing urine sampling by means of adhesive bags versus nappy pads. The contamination rate was 5% for clean catch, 30%-80% for adhesive bags and 64% for nappy pads. CONCLUSION Nappy pads and adhesive bags are easy to use with comparable accuracy but are extremely prone to contamination. Clean-catch urine sampling might be an accurate alternative in young infants in ambulatory care.
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Affiliation(s)
- Hanne Ann Boon
- EPI‐CentreAcademic Centre for General PracticeKU Leuven Leuven Belgium
| | - Wouter Lenaerts
- EPI‐CentreAcademic Centre for General PracticeKU Leuven Leuven Belgium
| | - Cedric Van Aerde
- EPI‐CentreAcademic Centre for General PracticeKU Leuven Leuven Belgium
| | - Jan Y. Verbakel
- EPI‐CentreAcademic Centre for General PracticeKU Leuven Leuven Belgium
- Nuffield Department of Primary Care Health Sciences University of OxfordRadcliffe Observatory Quarter Oxford UK
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Urine collection methods for infants under 3 months of age in clinical practice. Pediatr Nephrol 2021; 36:3899-3904. [PMID: 34100109 DOI: 10.1007/s00467-021-05142-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Methods of urine collection used in precontinent children are a controversial issue. Definitive diagnosis of urinary tract infection (UTI) requires an uncontaminated urine culture. We aimed to describe methods used to collect urine for culture in infants under 3 months of age and compare results and contamination rates. METHODS This retrospective observational cohort study included 721 urine cultures collected from infants <3 months of age at the Hospital Universitario Infanta Sofía, Madrid, between January 2016 and December 2019. Urine cultures were compared based on collection technique, sex, and patient age. RESULTS Median patient age was 36 days and 54.6% were male. In total, 592 (82.1%) samples were collected using clean-catch urine stimulation technique (CCUST), 77 (10.7%) by urethral catheterization (UC) and 52 (7.2%) by urine bag (UB). Positive cultures were obtained in 11.7% (95% confidence interval [CI] 9.1, 14.3) of CCUST samples and in 28.6% (95% CI 18.5, 38.7) of UC samples (p<0.001). The contamination rate was 13.7% (95% CI 10.9, 16.4] for CCUST, 23.1% (95% CI 11.6, 34.6) for UB and 5.2% (95% CI 0.2, 10.2) for UC, with statistically significant differences (p=0.007) between UB and UC collection. CONCLUSIONS CCUST is the most commonly used method in our hospital for collecting urine in infants younger than 3 months. The contamination rate of UC is lower but not significantly different to that of CCUST. Urine collection by CCUST serves as a non-invasive alternative to UC for diagnosis of UTI in infants under 3 months of age in routine clinical practice. Graphical abstract.
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Mousa AM, Allemailem KS, Alhumaydhi FA, Alrumaihi F, Almatroudi A, Alwashmi AS, Aljasir M, Al Rugaie O, Aljohani ASM, Soliman KEA, Rezk MY, Hegazy AMS, Seleem HS. Could Mesna and Celery Seed Cotherapy Modulate Oxidative Stress and Inflammation of the Urinary Bladder Induced by Ifosfamide in Rabbits? J Inflamm Res 2021; 14:5837-5847. [PMID: 34795496 PMCID: PMC8594558 DOI: 10.2147/jir.s337405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Ifosfamide (IFS) has potential complications such as nephropathy and hemorrhagic cystitis (HC). Although mesna can prevent IFS-induced cystitis by direct binding and neutralization of acrolein, HC symptoms have still been observed clinically in most of these cases. Celery is a powerful healing vegetable that has antioxidant, anti-inflammatory, and anticancer effects. The current study evaluated the synergistic effects of mesna and celery seed on IFS-induced HC in rabbits. Methods Twenty male rabbits (four groups) were administered distilled water, IFS, mesna, and mesna+celery seed cotherapy (MCC) for three weeks. The serum and urinary bladder of experimental rabbits underwent biochemical (TNF-α, MDA, iNOS, SOD, GPx, and CAT), histopathological and ultrastructural investigations to evaluate the structural changes of the urinary bladder (UB). Results IFS injection resulted in severe cystitis with a remarkable increase in the scale of hematuria, elevations of TNF-α, MDA, and iNOS activity, and reduced activity of SOD, GPx, and CAT antioxidants. Additionally, the structure of UB exhibited evident mucosal edema and ulceration. In contrast, the MCC regimen group revealed partial synergistic improvement of all mentioned parameters. Conclusion IFS induced cystitis by releasing acrolein, which exerted a significant role in the pathogenesis of HC. In contrast, the MCC intake partially ameliorated the UB damage through its antioxidant and anti-inflammatory effects.
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Affiliation(s)
- Ayman M Mousa
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia.,Department of Histology and Cell Biology, Faculty of Medicine, Benha University, Benha, 13518, Egypt
| | - Khaled S Allemailem
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia.,Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia
| | - Fahad A Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia
| | - Faris Alrumaihi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia
| | - Ameen S Alwashmi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia
| | - Mohammad Aljasir
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, 51452, Saudi Arabia
| | - Osamah Al Rugaie
- Department of Basic Medical Sciences, College of Medicine and Medical Sciences, Qassim University, Unaizah, 51452, Saudi Arabia
| | - Abdullah S M Aljohani
- Department of Veterinary Medicine, College of Agricultural and Veterinary Medicine, Qassim University, Buraydah, 51452, Saudi Arabia
| | - Khaled E A Soliman
- Department of Basic Medical Sciences, College of Medicine and Medical Sciences, Qassim University, Unaizah, 51452, Saudi Arabia.,Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Sohag University, Sohag, 82524, Egypt
| | - Mohamad Y Rezk
- Department of Basic Medical Sciences, College of Medicine and Medical Sciences, Qassim University, Unaizah, 51452, Saudi Arabia.,Department of Medical Physiology, Faculty of Medicine, Zagazig University, Al-Sharquia, 44519, Egypt
| | - Ahmed M S Hegazy
- Department of Anatomy, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia.,Department of Anatomy and Embryology, Faculty of Medicine, Benha University, Benha, 13518, Egypt
| | - Hanan S Seleem
- Department of Basic Medical Sciences, College of Medicine and Medical Sciences, Qassim University, Unaizah, 51452, Saudi Arabia.,Department of Histology and Cell Biology, Faculty of Medicine, Menoufia University, Shebin Elkoum, Egypt
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