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Aerococcus urinae - significance of detection in the paediatric urinary tract: a case series. Eur J Pediatr 2023; 182:749-756. [PMID: 36472648 PMCID: PMC9899180 DOI: 10.1007/s00431-022-04730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
Aerococcus urinae (A. urinae) is primarily recognized as a common pathogen in the geriatric population, causing urinary tract infection (UTI), sepsis, and endocarditis, predominantly in female patients. In the paediatric population, only a few case reports exist suggesting A. urinae causes malodorous urine in otherwise healthy boys. In this study, we investigated the spectrum of clinical and laboratory presentations of A. urinae detection in children. A retrospective, single-centre, case series including all patients with the detection of A. urinae during a 7-year study period. Patients with detection of A. urinae only in non-urogenital skin swabs were excluded. A total of 40 samples from 33 patients were identified of which 20 patients were included in the final analysis. The median (IQR) age was 6.8 (2.9-9.5) years; 18 (90%) patients were boys. Four patients were diagnosed with a UTI, six had malodorous urine without UTI, three were diagnosed with balanitis and seven showed A. urinae colonization in the urine culture. Urogenital disorders were present in 12 patients. Additional pathogens were detected in 13 patients. Recurrence of detection during our study period was observed in four (20%) patients. Conclusion: Beyond malodorous urine, A. urinae detection is associated with more severe presentations including UTI in the paediatric population. Pre-existing urogenital disorders were frequent, and therefore, a nephro-urological investigation should be considered in all cases of A. urinae detection in the paediatric population. What is Known: • Aerococcus urinae (A. urinae) is known to be a common pathogen in the geriatric population, causing urinary tract infection (UTI), sepsis, and endocarditis, predominantly in female patients. • In the paediatric population, A. urinae is mainly described as a low-grade pathogen. Some case reports describe A. urinae as the cause of extraordinary malodorous urine in otherwise healthy boys. What is New: • Beyond malodorous urine, A. urinae detection is associated with more severe presentations including UTI in the paediatric population. • A. urinae was mainly detected in boys with pre-existing urogenital disorders; therefore, a nephro-urological investigation should be considered in cases of A. urinae detection in the paediatric population.
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Campbell A, Hartling L, Louie-Poon S, Scott SD. Exploring the Experiences and Information Needs of Parents Caring for a Child With a Urinary Tract Infection: A Qualitative Study. J Patient Exp 2021; 8:23743735211008299. [PMID: 34179429 PMCID: PMC8205397 DOI: 10.1177/23743735211008299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Urinary tract infections (UTIs) are common in children, however, clinical
practice variations can leave parents unsure how to care for their child. We aim
to develop knowledge tools that provide evidence-based information about
pediatric UTIs. To inform tool development, we asked parents to share their
experiences and information needs in caring for a child with a UTI. Using
qualitative description methods, 16 semistructured interviews were conducted
with 18 parents. Parents were recruited through the emergency department (ED) of
a major Canadian urban pediatric hospital. Five major themes emerged: (1) parent
descriptions of their child’s symptoms and behaviors; (2) UTIs have an effect on
the entire family; (3) reasons for going to the ED; (4) parent experiences with
UTI treatment, management, and follow-up strategies for their child; and (5)
parent information needs and preferred information sources for UTIs. Our
findings highlight the diversity of UTI symptoms children experience, which
causes uncertainty and confusion for parents. This diversity suggests the
development of knowledge tools for parents about UTIs is needed.
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Affiliation(s)
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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Fahimi D, Khedmat L, Afshin A, Noparast Z, Jafaripor M, Beigi EH, Ghodsi M, Izadi A, Mojtahedi SY. Clinical manifestations, laboratory markers, and renal ultrasonographic examinations in 1-month to 12-year-old Iranian children with pyelonephritis: a six-year cross-sectional retrospective study. BMC Infect Dis 2021; 21:189. [PMID: 33602159 PMCID: PMC7890627 DOI: 10.1186/s12879-021-05887-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Upper urinary tract infection (UTI) or pyelonephritis may increase the pathogenesis rate and risk of severe complications in children due to kidney atrophy. OBJECTIVE A set of clinical symptoms, laboratory markers, and ultrasound findings were assessed to achieve the early diagnosis and prognosis of pyelonephritis in hospitalized pediatrics. METHODS A cross-sectional study with 104 Iranian children (95 girls and 9 boys) aged 1 month to 12 years with acute pyelonephritis during 2012-2018 was conducted. The ultrasound examination of kidneys and urinary tract during hospitalization, the incidence of clinical symptoms, and laboratory markers in blood and urine were monitored to identify the best predictive factors of early diagnosis of this bacterial infection. RESULTS Three-fourth of the patients had one of the four clinical symptoms of abdominal pain, constipation, dysuria, and vomiting, while others were asymptomatic. A much frequency of pyuria (88.46%), Escherichia coli in urine (92.31%), leukocytosis (81.73%), and high ESR (> 10 mm/h, 92.30%) and CRP (> 10 mg/L, 82.82%) was observed. The kidney and urinary tract ultrasonography only in 32.7% of children revealed findings in favor of pyelonephritis (cystitis, ureteral stones, and hydronephrosis). CONCLUSION There was a high frequency of clinical signs and laboratory markers associated with pyelonephritis. Ultrasound alone was not an efficient tool to track febrile UTI as most patients presented normal sonography.
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Affiliation(s)
- Daryoosh Fahimi
- Children’s Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khedmat
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Azadeh Afshin
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Noparast
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Jafaripor
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Effat Hosseinali Beigi
- Department of Pediatric Intensive Care Unit, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghodsi
- Department of Pediatric Intensive Care Unit, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Izadi
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Smell - Adding a New Dimension to Urinalysis. BIOSENSORS-BASEL 2020; 10:bios10050048. [PMID: 32380781 PMCID: PMC7277101 DOI: 10.3390/bios10050048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 11/22/2022]
Abstract
Background: Urinary tract infections (UTI) are among the most common infections in children. The primary tool to detect UTI is dipstick urinalysis; however, this has limited sensitivity and specificity. Therefore, urine culture has to be performed to confirm a UTI. Urinary volatile organic compounds (VOC) may serve as potential biomarker for diagnosing UTI. Previous studies on urinary VOCs focused on detection of UTI in a general population; therefore, this proof-of-principle study was set up in a clinical high-risk pediatric population. Methods: This study was performed at a tertiary nephro-urological clinic. Patients included were 0–18 years, clinically suspected of a UTI, and had abnormal urinalysis. Urine samples were divided into four groups, i.e., urine without bacterial growth, contamination, colonization, and UTI. VOC analysis was performed using an electronic nose (eNose) (Cyranose 320®) and VOC profiles of subgroups were compared. Results: Urinary VOC analysis discriminated between UTI and non-UTI samples (AUC 0.70; p = 0.048; sensitivity 0.67, specificity 0.70). The diagnostic accuracy of VOCs improved when comparing urine without bacterial growth versus with UTI (AUC 0.80; p = 0.009, sensitivity 0.79, specificity 0.75). Conclusions: In an intention-to-diagnose high-risk pediatric population, UTI could be discriminated from non-UTI by VOC profiling, using an eNose. Since eNose can be used as bed-side test, these results suggest that urinary VOC analysis may serve as an adjuvant in the diagnostic work-up of UTI in children.
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Stephanos K, Bragg AF. Pediatric Genitourinary Infections and Other Considerations. Emerg Med Clin North Am 2019; 37:739-754. [PMID: 31563205 DOI: 10.1016/j.emc.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pediatric patients pose a unique host of challenges to the emergency provider across all complaints and ages, but this is particularly notable in the genitourinary (GU) system. The pediatric GU system is different from that of the adult in its etiology of symptoms, complications, and treatments. Based on age, there are variations in the anatomy. These differences result in symptoms and diagnoses that must be managed differently. Although in many respects management is similar to GU emergency conditions in adults, there are, occasionally subtle, differences between the care of children and adults, which can greatly impact outcomes.
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Affiliation(s)
- Kathleen Stephanos
- Department of Emergency Medicine, University of Rochester, 601 Elmwood Avenue Box 655, Rochester, NY 14642, USA.
| | - Andrew F Bragg
- Department of Pediatrics, University of Rochester, 601 Elmwood Avenue Box 655, Rochester, NY 14642, USA
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Immunological and Molecular Study of Interleukin-17A and Uropathogenic E. coli among Patients in Holy Karbala, Iraq. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2019. [DOI: 10.22207/jpam.13.2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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7
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Gates A, Shulhan J, Featherstone R, Scott SD, Hartling L. A systematic review of parents' experiences and information needs related to their child's urinary tract infection. PATIENT EDUCATION AND COUNSELING 2018; 101:1207-1215. [PMID: 29395475 DOI: 10.1016/j.pec.2018.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE As a first step toward the development of an animated video and infographic to increase parents' knowledge of pediatric urinary tract infections (UTIs), we conducted a systematic review of their experiences and information needs. METHODS We searched Ovid Medline, Ovid PsycINFO, CINAHL, and ProQuest Dissertations and Theses Global for studies published in 2000 or thereafter. We appraised quality using the Mixed Methods Appraisal Tool. We summarised the quantitative data narratively and the qualitative data thematically. RESULTS We identified 1493 records and included four. Sample size ranged from 20 to 2726 parents. The children ranged from <1 to 12 years old and had experienced one to >10 UTIs. Parents were not always aware of UTI symptoms and generally received little information. Parents sought information online, and desired it via other means. Some parents were not confident in healthcare providers' (HCPs') knowledge of UTIs. Inadequate information about diagnostic tests sometimes resulted in fear and non-compliance. CONCLUSIONS From the limited literature, it appears that parents would like information about prevention, diagnosis, treatment, and prognosis, but do not always consider HCPs good information sources. PRACTICE IMPLICATIONS Care providers should communicate information in ways that suit parents' self-identified needs.
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Affiliation(s)
- Allison Gates
- Alberta Research Centre for Health Evidence (ARCHE) and the Department of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Jocelyn Shulhan
- Alberta Research Centre for Health Evidence (ARCHE) and the Department of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence (ARCHE) and the Department of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE) and the Department of Pediatrics, University of Alberta, Edmonton, Canada.
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8
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Ryakitimbo A, Philemon R, Mazuguni F, Msuya L. Prevalence and antimicrobial sensitivity pattern of urinary tract infection among children with cerebral palsy, Moshi, Tanzania. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2018; 9:59-65. [PMID: 29774893 PMCID: PMC5947104 DOI: 10.2147/phmt.s159766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Urinary tract infection (UTI) in children with cerebral palsy (CP) is a challenging yet common clinical condition. Children with CP bare the greatest risk of contracting UTI because of their difficulties in neuromotor control which lead to delay of bladder control, causing incomplete bladder emptying and urine retention. Method This was an analytical cross-sectional study that was conducted from September 2016 to March 2017 at Comprehensive Community Based Rehabilitation in Tanzania – Moshi and Kilimanjaro Christian Medical Centre Neurological Pediatrics Outpatient Clinic. All children who met the inclusion criteria were studied. Urine samples were collected at one point by catheterization, and urine dipstick and urine culture were done. Data were analyzed using SPSS version 20. Results A total of 99 children were enrolled in the study. The median age was 4 years (3–8 years); 53.5% were aged between 2 and 4 years. More than half were male. UTI was detected in 13.1% (n=13) of the children. Five causative agents of UTI were isolated, namely Escherichia coli, Proteus mirabilis, Klebsiella pneumonia, Staphylococcus aureus, and Enterococcus faecalis. The two most common organisms, E. coli and P. mirabilis, both had low sensitivity to ampicillin and co-trimoxazole while they were sensitive to ciprofloxacin and ceftriaxone. Conclusion UTI is a common finding among children with CP. E. coli and P. mirabilis are the commonest causative agents and are sensitive to ciprofloxacin and ceftriaxone but have low sensitivity to ampicillin and co-trimoxazole.
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Affiliation(s)
- Amon Ryakitimbo
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rune Philemon
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Pediatric and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Festo Mazuguni
- Department of Epidemiology and Applied Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Levina Msuya
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Pediatric and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Hay AD, Birnie K, Busby J, Delaney B, Downing H, Dudley J, Durbaba S, Fletcher M, Harman K, Hollingworth W, Hood K, Howe R, Lawton M, Lisles C, Little P, MacGowan A, O'Brien K, Pickles T, Rumsby K, Sterne JA, Thomas-Jones E, van der Voort J, Waldron CA, Whiting P, Wootton M, Butler CC. The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness. Health Technol Assess 2018; 20:1-294. [PMID: 27401902 DOI: 10.3310/hta20510] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment. OBJECTIVES To develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness. DESIGN Multicentre, prospective diagnostic cohort study. SETTING AND PARTICIPANTS Children < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms. METHODS One hundred and seven clinical characteristics (index tests) were recorded from the child's past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood ('clinical diagnosis') and urine sampling and treatment intentions ('clinical judgement') were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 10(5) colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the 'clinician diagnosis' AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with 'clinical judgement'. RESULTS A total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, 'clinical diagnosis' correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were < 2 years old and 1.3% met the UTI definition. 'Clinical diagnosis' correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut. CONCLUSIONS Clinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Alastair D Hay
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Birnie
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Busby
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Brendan Delaney
- Department of Primary Care and Public Health Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Harriet Downing
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jan Dudley
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Stevo Durbaba
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK
| | - Margaret Fletcher
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK.,South West Medicines for Children Local Research Network, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kim Harman
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Robin Howe
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Cardiff, UK
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Catherine Lisles
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | | | - Kathryn O'Brien
- Cochrane Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Timothy Pickles
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Kate Rumsby
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Jonathan Ac Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Judith van der Voort
- Department of Paediatrics and Child Health, University Hospital of Wales, Cardiff, UK
| | - Cherry-Ann Waldron
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Penny Whiting
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Cardiff, UK
| | - Christopher C Butler
- Cochrane Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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10
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Affiliation(s)
- Alexandra Hudson
- Dalhousie Medical School (Hudson); Departments of Surgery and Urology (Romao), and of Urology and Pathology (MacLellan), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Rodrigo L P Romao
- Dalhousie Medical School (Hudson); Departments of Surgery and Urology (Romao), and of Urology and Pathology (MacLellan), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Dawn MacLellan
- Dalhousie Medical School (Hudson); Departments of Surgery and Urology (Romao), and of Urology and Pathology (MacLellan), Faculty of Medicine, Dalhousie University, Halifax, NS
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11
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Hay AD, Sterne JAC, Hood K, Little P, Delaney B, Hollingworth W, Wootton M, Howe R, MacGowan A, Lawton M, Busby J, Pickles T, Birnie K, O'Brien K, Waldron CA, Dudley J, Van Der Voort J, Downing H, Thomas-Jones E, Harman K, Lisles C, Rumsby K, Durbaba S, Whiting P, Butler CC. Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study. Ann Fam Med 2016; 14:325-36. [PMID: 27401420 PMCID: PMC4940462 DOI: 10.1370/afm.1954] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/07/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. Our aim was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment. METHODS We recruited acutely unwell children aged under 5 years from 233 primary care sites across England and Wales. Index tests were parent-reported symptoms, clinician-reported signs, urine dipstick results, and clinician opinion of UTI likelihood (clinical diagnosis before dipstick and culture). The reference standard was microbiologically confirmed UTI cultured from a clean-catch urine sample. We calculated sensitivity, specificity, and area under the receiver operator characteristic (AUROC) curve of coefficient-based (graded severity) and points-based (dichotomized) symptom/sign logistic regression models, and we then internally validated the AUROC using bootstrapping. RESULTS Three thousand thirty-six children provided urine samples, and culture results were available for 2,740 (90%). Of these results, 60 (2.2%) were positive: the clinical diagnosis was 46.6% sensitive, with an AUROC of 0.77. Previous UTI, increasing pain/crying on passing urine, increasingly smelly urine, absence of severe cough, increasing clinician impression of severe illness, abdominal tenderness on examination, and normal findings on ear examination were associated with UTI. The validated coefficient- and points-based model AUROCs were 0.87 and 0.86, respectively, increasing to 0.90 and 0.90, respectively, by adding dipstick nitrites, leukocytes, and blood. CONCLUSIONS A clinical rule based on symptoms and signs is superior to clinician diagnosis and performs well for identifying young children for noninvasive urine sampling. Dipstick results add further diagnostic value for empiric antibiotic treatment.
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Affiliation(s)
- Alastair D Hay
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Paul Little
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, United Kingdom
| | - Brendan Delaney
- Guys' and St Thomas' Charity Chair in Primary Care Research, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Department of Primary Care and Public Health Sciences, London, United Kingdom
| | - William Hollingworth
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff, United Kingdom
| | - Robin Howe
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff, United Kingdom
| | - Alasdair MacGowan
- North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - John Busby
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Timothy Pickles
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Kate Birnie
- School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Kathryn O'Brien
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Cherry-Ann Waldron
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Jan Dudley
- Bristol Royal Hospital for Children, University Hospitals Bristol, NHS Foundation Trust, Bristol, United Kingdom
| | - Judith Van Der Voort
- Department of Paediatrics and Child Health, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - Harriet Downing
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Kim Harman
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, United Kingdom
| | - Catherine Lisles
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Kate Rumsby
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, United Kingdom
| | - Stevo Durbaba
- King's College London, Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, London, United Kingdom
| | - Penny Whiting
- NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, United Kingdom, and General Practitioner, Cwm Taf University Health Board, Wales, United Kingdom
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Sharef SW, El-Naggari M, Al-Nabhani D, Al Sawai A, Al Muharrmi Z, Elnour I. Incidence of antibiotics resistance among uropathogens in Omani children presenting with a single episode of urinary tract infection. J Infect Public Health 2015; 8:458-65. [PMID: 25755002 DOI: 10.1016/j.jiph.2015.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/24/2014] [Accepted: 01/23/2015] [Indexed: 11/19/2022] Open
Abstract
Urinary tract infection (UTI) is one of the most common community-acquired infections. Different organisms can be the cause of UTI in children, with resistance to antibiotics becoming a significant problem in the choice of treatment. Worldwide studies have documented the prevalence of uropathogens in different countries. However, there is no previous study documenting the incidence of different uropathogens in Oman. We aim to report the most common uropathogens and their antibiotic sensitivity patterns in children presenting with documented, single episode UTI at a tertiary hospital in Oman. A retrospective analysis of all Omani children below 14 years who presented with a case of first documented UTI to SQUH between September 2008 and August 2012 was conducted. Data were obtained from the patients' electronic records in the hospital information system. Data were then analyzed using SSPS (Statistical Package for Social Sciences program, Version 20, IBM, Chicago, IL, USA). In the retrospective review of all urine cultures, 438 positive urine cultures were identified. Out of those, 208 (47.5%) belonged to children with their first episode of UTI. Thirty-three patients were excluded and 75 patients were included in the final analysis. Escherichia coli was the most frequently encountered uropathogen in our cohort (69%), followed by Klebsiella pneumoniae infection (17%). Nearly half (46.6%) of these two common organism were resistant to Cotrimoxazole, while 31% of them were resistant to Augmentin. Twenty-four percent of the E. coli and K. pneumoniae strains were resistant to Cefuroxime, and only 10% were resistant to nitrofurantoin. Both Augmentin and Cotrimoxazole should not be the first line antibiotics to treat UTI.
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Affiliation(s)
- Sharef W Sharef
- Sultan Qaboos University Hospital, Child Health Department, Muscat, Oman
| | - Mohamed El-Naggari
- Sultan Qaboos University Hospital, Child Health Department, Muscat, Oman.
| | - Dana Al-Nabhani
- Sultan Qaboos University Hospital, Child Health Department, Muscat, Oman
| | - Ali Al Sawai
- Sultan Qaboos University Hospital, Child Health Department, Muscat, Oman
| | | | - Ibtisam Elnour
- Sultan Qaboos University Hospital, Child Health Department, Muscat, Oman
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Gauthier M, Gouin S, Phan V, Gravel J. Association of malodorous urine with urinary tract infection in children aged 1 to 36 months. Pediatrics 2012; 129:885-90. [PMID: 22473364 DOI: 10.1542/peds.2011-2856] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether parental reporting of malodorous urine is associated with urinary tract infection (UTI) in children. METHODS We conducted a prospective consecutive cohort study in the emergency department of a pediatric hospital from July 31, 2009 to April 30, 2011. All children aged between 1 and 36 months for whom a urine culture was prescribed for suspected UTI (ie, unexplained fever, irritability, or vomiting) were assessed for eligibility. A standardized questionnaire was administered to the parents by a research assistant. The primary outcome measure was a UTI. RESULTS Three hundred ninety-six children were initially enrolled, but 65 were excluded a posteriori either because a urine culture, although prescribed, was not done (11), was collected by bag (39), and/or showed gross contamination (25). Therefore, 331 children were included in the final analysis. Their median age was 12 months (range, 1-36). Criteria for UTI were fulfilled in 51 (15%). A malodorous urine was reported by parents in 57% of children with UTI and in 32% of children without UTI. On logistic regression, malodorous urine was associated with UTI (odds ratio 2.83, 95% confidence interval: 1.54-5.20). This association remained statistically significant when adjusted for gender and the presence of vesicoureteral reflux (odds ratio 2.73, 95% confidence interval: 1.46-5.08). CONCLUSIONS Parental reporting of malodorous urine increases the probability of UTI among young children being evaluated for suspected UTI. However, this association is not strong enough to definitely rule in or out a diagnosis of UTI.
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Affiliation(s)
- Marie Gauthier
- Division of General Pediatrics, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Canada.
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Abstract
BACKGROUND Knowledge of baseline risk of urinary tract infection can help clinicians make informed diagnostic and therapeutic decisions. We conducted a meta-analysis to determine the pooled prevalence of urinary tract infection (UTI) in children by age, gender, race, and circumcision status. METHODS MEDLINE and EMBASE databases were searched for articles about pediatric urinary tract infection. Search terms included urinary tract infection, cystitis, pyelonephritis, prevalence and incidence. We included articles in our review if they contained data on the prevalence of UTI in children 0-19 years of age presenting with symptoms of UTI. Of the 51 articles with data on UTI prevalence, 18 met all inclusion criteria. Two evaluators independently reviewed, rated, and abstracted data from each article. RESULTS Among infants presenting with fever, the overall prevalence (and 95% confidence interval) of UTI was 7.0% (CI: 5.5-8.4). The pooled prevalence rates of febrile UTIs in females aged 0-3 months, 3-6 months, 6-12 months, and >12 months was 7.5%, 5.7%, 8.3%, and 2.1% respectively. Among febrile male infants less than 3 months of age, 2.4% (CI: 1.4-3.5) of circumcised males and 20.1% (CI: 16.8-23.4) of uncircumcised males had a UTI. For the 4 studies that reported UTI prevalence by race, UTI rates were higher among white infants 8.0% (CI: 5.1-11.0) than among black infants 4.7% (CI: 2.1-7.3). Among older children (<19 years) with urinary symptoms, the pooled prevalence of UTI (both febrile and afebrile) was 7.8% (CI: 6.6-8.9). CONCLUSIONS Prevalence rates of UTI varied by age, gender, race, and circumcision status. Uncircumcised male infants less than 3 months of age and females less than 12 months of age had the highest baseline prevalence of UTI. Prevalence estimates can help clinicians make informed decisions regarding diagnostic testing in children presenting with signs and symptoms of urinary tract infection.
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Schimpf MO, Murdza M, O'Sullivan DM, Tulikangas PK, LaSala CA. Can community-dwelling women reliably identify infected urine? Int Urogynecol J 2007; 18:1357-61. [PMID: 17356798 DOI: 10.1007/s00192-007-0343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 02/25/2007] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to evaluate whether community-dwelling women can reliably identify infected urine samples. A convenience sample of 25 women judged six urine samples. Of these, two were normal, two contained culture-proven infections, and two were intentionally abnormal because of ingestion of asparagus or vitamins. The women decided if each sample was infected based on its color, clarity, and odor. For the two normal samples, 56 and 96% women correctly identified them. Of the two samples positive for infection, women were correct 80 and 100% of the time. Of the two samples designed to be abnormal, women were correct in 92 and 64% of their evaluations. Using the 150 total evaluations of urine samples, the sensitivity was 90%, and the specificity was 77%. Based on this small sample, community-dwelling women can detect infected samples of urine. However, women should still be screened for factors that might have distorted normal urine.
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Affiliation(s)
- Megan O Schimpf
- Department of Obstetrics and Gynecology, Division of Urogynecology, Hartford Hospital, Hartford, CT, USA.
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Westwood ME, Whiting PF, Kleijnen J. How does study quality affect the results of a diagnostic meta-analysis? BMC Med Res Methodol 2005; 5:20. [PMID: 15943861 PMCID: PMC1180444 DOI: 10.1186/1471-2288-5-20] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 06/08/2005] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. METHODS This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. RESULTS Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. CONCLUSION Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited.
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Affiliation(s)
| | - Penny F Whiting
- Centre for Reviews and Dissemination, University of York, UK
| | - Jos Kleijnen
- Centre for Reviews and Dissemination, University of York, UK
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