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Gupta J, Zipursky AR, Pirie J, Freire G, Karin A, Bohn MK, Adeli K, Ostrow O. Coming in Hot: A quality improvement approach to improving care of febrile infants. Paediatr Child Health 2024; 29:135-143. [PMID: 38827372 PMCID: PMC11141599 DOI: 10.1093/pch/pxad070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/09/2023] [Indexed: 06/04/2024] Open
Abstract
Background and Objectives Significant practice variation exists in managing young infants with fever. Quality improvement strategies can aid in risk stratification and standardization of best care practices, along with a reduction of unnecessary interventions. The aim of this initiative was to safely reduce unnecessary admissions, antibiotics, and lumbar punctures (LPs) by 10% in low-risk, febrile infants aged 29 to 90 days presenting to the emergency department (ED) over a 12-month period. Methods Using the Model for Improvement, a multidisciplinary team developed a multipronged intervention: an updated clinical decision tool (CDT), procalcitonin (PCT) adoption, education, a feedback tool, and best practice advisory (BPA) banner. Outcome measures included the proportion of low-risk infants that were admitted, received antibiotics, and had LPs. Process measures were adherence to the CDT and percentage of PCT ordered. Missed bacterial infections and return visits were balancing measures. The analysis was completed using descriptive statistics and statistical process control methods. Results Five hundred and sixteen patients less than 90 days of age were included in the study, with 403 patients in the 29- to 90-day old subset of primary interest. In the low-risk group, a reduction in hospital admissions from a mean of 24.1% to 12.0% and a reduction in antibiotics from a mean of 15.2% to 1.3% was achieved. The mean proportion of LPs performed decreased in the intervention period from 7.5% to 1.8%, but special cause variation was not detected. Adherence to the CDT increased from 70.4% to 90.9% and PCT was ordered in 92.3% of cases. The proportion of missed bacterial infections was 0.3% at baseline and 0.5% in the intervention period while return visits were 6.7% at baseline and 5.0% in the intervention period. Conclusions The implementation of a quality improvement strategy, including an updated evidence-based CDT for young infant fever incorporating PCT, safely reduced unnecessary care in low-risk, febrile infants aged 29 to 90 days in the ED. Purpose To develop and implement a multipronged improvement strategy including an evidence-based CDT utilizing PCT to maximize value of care delivered to well-appearing, febrile infants presenting to EDs.
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Affiliation(s)
- Joel Gupta
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Amy R Zipursky
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Pirie
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Gabrielle Freire
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Amir Karin
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Kathryn Bohn
- Department of Laboratory Medicine, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Khosrow Adeli
- Department of Laboratory Medicine, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Olivia Ostrow
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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2
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Bohn MK, Havelka A, Eriksson M, Adeli K. Validation of Serum Calprotectin Relative to Other Biomarkers of Infection in Febrile Infants Presenting to the Emergency Department. Antibiotics (Basel) 2024; 13:425. [PMID: 38786153 PMCID: PMC11117379 DOI: 10.3390/antibiotics13050425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Antimicrobial stewardship involves a delicate balance between the risk of undertreating individuals and the potential societal burden of overprescribing antimicrobials. This balance is especially crucial in neonatal care. In this observational study, the usefulness of biomarkers of infectious diseases (calprotectin, procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBCs) were evaluated in 141 febrile infants aged 28-90 days presenting to an emergency department. Since our focus was on the usefulness of serum calprotectin, this biomarker was not part of clinical decision-making. A significant difference was observed in the levels of all biomarkers, related to final discharge diagnosis and disposition status. The difference in levels related to antibiotic prescription was significant for all biomarkers but WBCs. The performance of calprotectin in the detection of bacterial infections (AUC (95% CI): 0.804 (0.691, 0.916)) was comparable to the performance of both PCT (0.901 (0.823, 0.980)) and CRP (0.859 (0.764, 0.953)) and superior to the WBC count (0.684 (0.544, 0.823)). Procalcitonin and CRP demonstrated a statistically significantly higher specificity relative to calprotectin. In this cohort, antibiotic use did not always correlate to a definite diagnosis of confirmed bacterial infection. The sample size was limited due to associated challenges with recruiting febrile infants. Hence, there is a need for adequate diagnostic tools to help discriminate between various kinds of infections. This study suggests serum calprotectin, procalcitonin, and CRP may serve as valuable biomarkers to differentiate between types of infection, in addition to clinical input and decision-making.
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Affiliation(s)
- Mary Kathryn Bohn
- Department of Pathology and Laboratory Medicine, University of Toronto, Toronto, ON M5G 1X8, Canada;
- Molecular Medicine, SickKids Research Institute, Toronto, ON M5G 0A4, Canada
| | - Aleksandra Havelka
- Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76 Stockholm, Sweden;
- Gentian AS, 1596 Moss, Norway
| | - Mats Eriksson
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden;
- NOVA Medical School, New University of Lisbon, 1099-085 Lisbon, Portugal
| | - Khosrow Adeli
- Department of Pathology and Laboratory Medicine, University of Toronto, Toronto, ON M5G 1X8, Canada;
- Molecular Medicine, SickKids Research Institute, Toronto, ON M5G 0A4, Canada
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3
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Marsh MC, Junquera GY, Stonebrook E, Spencer JD, Watson JR. Urinary Tract Infections in Children. Pediatr Rev 2024; 45:260-270. [PMID: 38689106 DOI: 10.1542/pir.2023-006017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Despite the American Academy of Pediatrics guidelines for the evaluation, treatment, and management of urinary tract infections (UTIs), UTI diagnosis and management remains challenging for clinicians. Challenges with acute UTI management stem from vague presenting signs and symptoms, diagnostic uncertainty, limitations in laboratory testing, and selecting appropriate antibiotic therapy in an era with increasing rates of antibiotic-resistant uropathogens. Recurrent UTI management remains difficult due to an incomplete understanding of the factors contributing to UTI, when to assess a child with repeated infections for kidney and urinary tract anomalies, and limited prevention strategies. To help reduce these uncertainties, this review provides a comprehensive overview of UTI epidemiology, risk factors, diagnosis, treatment, and prevention strategies that may help pediatricians overcome the challenges associated with acute and recurrent UTI management.
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Affiliation(s)
- Melanie C Marsh
- Division of Hospital Medicine, Department of Pediatrics, Advocate Aurora Atrium Health Systems, Chicago, IL
| | - Guillermo Yepes Junquera
- Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Division of Infectious Diseases
| | - Emily Stonebrook
- Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Division of Nephrology and Hypertension, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - John David Spencer
- Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Division of Nephrology and Hypertension, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Joshua R Watson
- Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OH
- Division of Infectious Diseases
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Burstein B, Lirette MP, Beck C, Chauvin-Kimoff L, Chan K. La prise en charge des nourrissons de 90 jours ou moins, fiévreux mais dans un bon état général. Paediatr Child Health 2024; 29:50-66. [PMID: 38332975 PMCID: PMC10848124 DOI: 10.1093/pch/pxad084] [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: 12/14/2021] [Accepted: 06/15/2022] [Indexed: 02/10/2024] Open
Abstract
On constate des pratiques très variées en matière d'évaluation et de prise en charge des jeunes nourrissons fiévreux. Bien que la plupart des jeunes nourrissons fiévreux mais dans un bon état général soient atteints d'une maladie virale, il est essentiel de détecter ceux qui sont à risque de présenter des infections bactériennes invasives, notamment une bactériémie et une méningite bactérienne. Le présent document de principes porte sur les nourrissons de 90 jours ou moins dont la température rectale est de 38,0 °C ou plus, mais qui semblent être dans un bon état général. Il est conseillé d'appliquer les récents critères de stratification du risque pour orienter la prise en charge, ainsi que d'intégrer la procalcitonine à l'évaluation diagnostique. Les décisions sur la prise en charge des nourrissons qui satisfont aux critères de faible risque devraient refléter la probabilité d'une maladie, tenir compte de l'équilibre entre les risques et les préjudices potentiels et faire participer les parents ou les proches aux décisions lorsque diverses options sont possibles. La prise en charge optimale peut également dépendre de considérations pragmatiques, telles que l'accès à des examens diagnostiques, à des unités d'observation, à des soins tertiaires et à un suivi. Des éléments particuliers, tels que la mesure de la température, le risque d'infection invasive à Herpes simplex et la fièvre postvaccinale, sont également abordés.
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Affiliation(s)
- Brett Burstein
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | - Marie-Pier Lirette
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | - Carolyn Beck
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | | | - Kevin Chan
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
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5
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Burstein B, Lirette MP, Beck C, Chauvin-Kimoff L, Chan K. Management of well-appearing febrile young infants aged ≤90 days. Paediatr Child Health 2024; 29:50-66. [PMID: 38332970 PMCID: PMC10848123 DOI: 10.1093/pch/pxad085] [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: 12/14/2021] [Accepted: 06/15/2022] [Indexed: 02/10/2024] Open
Abstract
The evaluation and management of young infants presenting with fever remains an area of significant practice variation. While most well-appearing febrile young infants have a viral illness, identifying those at risk for invasive bacterial infections, specifically bacteremia and bacterial meningitis, is critical. This statement considers infants aged ≤90 days who present with a rectal temperature ≥38.0°C but appear well otherwise. Applying recent risk-stratification criteria to guide management and incorporating diagnostic testing with procalcitonin are advised. Management decisions for infants meeting low-risk criteria should reflect the probability of disease, consider the balance of risks and potential harm, and include parents/caregivers in shared decision-making when options exist. Optimal management may also be influenced by pragmatic considerations, such as access to diagnostic investigations, observation units, tertiary care, and follow-up. Special considerations such as temperature measurement, risk for invasive herpes simplex infection, and post-immunization fever are also discussed.
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Affiliation(s)
- Brett Burstein
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Marie-Pier Lirette
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Carolyn Beck
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | | | - Kevin Chan
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
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6
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Ghosheh GO, St John TL, Wang P, Ling VN, Orquiola LR, Hayat N, Shamout FE, Almallah YZ. Development and validation of a parsimonious prediction model for positive urine cultures in outpatient visits. PLOS DIGITAL HEALTH 2023; 2:e0000306. [PMID: 37910466 PMCID: PMC10619807 DOI: 10.1371/journal.pdig.0000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/22/2023] [Indexed: 11/03/2023]
Abstract
Urine culture is often considered the gold standard for detecting the presence of bacteria in the urine. Since culture is expensive and often requires 24-48 hours, clinicians often rely on urine dipstick test, which is considerably cheaper than culture and provides instant results. Despite its ease of use, urine dipstick test may lack sensitivity and specificity. In this paper, we use a real-world dataset consisting of 17,572 outpatient encounters who underwent urine cultures, collected between 2015 and 2021 at a large multi-specialty hospital in Abu Dhabi, United Arab Emirates. We develop and evaluate a simple parsimonious prediction model for positive urine cultures based on a minimal input set of ten features selected from the patient's presenting vital signs, history, and dipstick results. In a test set of 5,339 encounters, the parsimonious model achieves an area under the receiver operating characteristic curve (AUROC) of 0.828 (95% CI: 0.810-0.844) for predicting a bacterial count ≥ 105 CFU/ml, outperforming a model that uses dipstick features only that achieves an AUROC of 0.786 (95% CI: 0.769-0.806). Our proposed model can be easily deployed at point-of-care, highlighting its value in improving the efficiency of clinical workflows, especially in low-resource settings.
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Affiliation(s)
| | | | - Pengyu Wang
- NYU Abu Dhabi, Abu Dhabi, The United Arab Emirates
| | - Vee Nis Ling
- NYU Abu Dhabi, Abu Dhabi, The United Arab Emirates
| | | | - Nasir Hayat
- NYU Abu Dhabi, Abu Dhabi, The United Arab Emirates
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Oftedal TF, Diep DB. Flow cytometric detection of vancomycin-resistant Enterococcus faecium in urine using fluorescently labelled enterocin K1. Sci Rep 2023; 13:10930. [PMID: 37414859 PMCID: PMC10325980 DOI: 10.1038/s41598-023-38114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/03/2023] [Indexed: 07/08/2023] Open
Abstract
A urinary tract infection (UTI) occurs when bacteria enter and multiply in the urinary system. The infection is most often caused by enteric bacteria that normally live in the gut, which include Enterococcus faecium. Without antibiotic treatment, UTIs can progress to life-threatening septic shock. Early diagnosis and identification of the pathogen will reduce antibiotic use and improve patient outcomes. In this work, we develop and optimize a cost-effective and rapid (< 40 min) method for detecting E. faecium in urine. The method uses a fluorescently labelled bacteriocin enterocin K1 (FITC-EntK1) that binds specifically to E. faecium and is then detected using a conventional flow cytometer. Using this detection assay, urine containing E. faecium was identified by an increase in the fluorescent signals by 25-73-fold (median fluorescence intensity) compared to control samples containing Escherichia coli or Staphylococcus aureus. The method presented in this work is a proof of concept showing the potential of bacteriocins to act as specific probes for the detection of specific bacteria, such as pathogens, in biological samples.
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Affiliation(s)
- Thomas F Oftedal
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.
| | - Dzung B Diep
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
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8
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Tran M, Palmer S, Moore DT, Bartelt L, Friedland A, Grgic T, Lachiewicz A, Ptachcinski J, Sena A, Trepte M, van Duin D, Andermann TM, Shaw R. Utility of Urine Cultures During Febrile Neutropenia Workup in Hematopoietic Stem Cell Transplantation Recipients Without Urinary Symptoms. Open Forum Infect Dis 2023; 10:ofad236. [PMID: 37265665 PMCID: PMC10230562 DOI: 10.1093/ofid/ofad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
The utility of obtaining screening urine cultures for febrile neutropenia (FN) during hematopoietic stem cell transplant (HCT) is unknown. In 667 adult HCT patients with FN, only 40 (6%) were found with bacteriuria. Antibiotics were modified in 3 patients (0.4%) based on urine cultures and none developed urinary-associated infectious complications.
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Affiliation(s)
- Mya Tran
- Department of Pharmacy, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | - Shannon Palmer
- Department of Pharmacy, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Dominic T Moore
- Department of Biostatistics, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Luther Bartelt
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Anne Friedland
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Tatjana Grgic
- Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Anne Lachiewicz
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Jon Ptachcinski
- Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Arlene Sena
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Morgan Trepte
- Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Tessa M Andermann
- Correspondence: Tessa Andermann, MD, MPH, University of North Carolina at Chapel Hill, 111 Mason Farm Road, cb# 7036, Chapel Hill, NC, 27599-7036 (); Ryan Shaw, PharmD, BCPS, BCOP, University of North Carolina at Chapel Hill, 101 Manning Dr., Chapel Hill, NC, 27599
| | - Ryan Shaw
- Correspondence: Tessa Andermann, MD, MPH, University of North Carolina at Chapel Hill, 111 Mason Farm Road, cb# 7036, Chapel Hill, NC, 27599-7036 (); Ryan Shaw, PharmD, BCPS, BCOP, University of North Carolina at Chapel Hill, 101 Manning Dr., Chapel Hill, NC, 27599
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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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Holland JL, Ramgopal S, Money N, Graves C, Lo YH, Hashikawa A, Rogers A. Biomarkers and their association with bacterial illnesses in hypothermic infants. Am J Emerg Med 2023; 64:137-141. [PMID: 36528001 PMCID: PMC10368072 DOI: 10.1016/j.ajem.2022.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To describe the association of biomarkers with serious bacterial infection (SBI; urinary tract infection [UTI], bacteremia and/or bacterial meningitis) in hypothermic infants presenting to the emergency department (ED). METHODS We performed a cross sectional study in four academic pediatric EDs from January 2015 through December 2019, including infants ≤90 days old presenting with a rectal temperature of ≤36.4 °C. We constructed receiver operating characteristic (ROC) curves to evaluate the accuracy of blood biomarkers including white blood cell count (WBC), absolute neutrophil count (ANC) and platelets for identifying SBI, with exploratory analyses evaluating procalcitonin and band counts. RESULTS Among 850 included infants (53.5% males; median days of age 13 [IQR 5-58 days]), SBI were found in 55 (6.5%). For infants with SBI, the area under the curve (AUC; 95% confidence interval) for WBC was 0.70 (0.61-0.78) with sensitivity 0.64 (0.50-0.74) and specificity 0.77 (0.74-0.80). The AUC for ANC was 0.77 (0.70-0.84) with sensitivity 0.69 (0.55-0.81) and specificity 0.77 (0.74-0.8). For platelets, the AUC was 0.6 (0.52-0.67) with sensitivity 0.73 (0.59-0.84) and specificity 0.5 (0.46-0.53). Both the WBC and ANC were minimally accurate for identifying hypothermic infants with SBI. When looking at the accuracy of these biomarkers for identifying invasive bacterial infection (IBI; bacteremia and/or bacterial meningitis), ANC again showed minimal accuracy with an AUC of 0.70 (0.55-0.85). CONCLUSIONS Biomarkers commonly used as part of an infectious workup are generally poor at identifying SBI in hypothermic infants. Our findings from this cohort of hypothermic infants are similar to those reported from febrile infants, suggesting similarities in the bioresponse to infection between hypothermic and febrile infants. Additional research is required to improve risk stratification for hypothermic infants, and to better guide evaluation and management.
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Affiliation(s)
- Jamie L Holland
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan Money
- Division of Pediatric Hospital Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christopher Graves
- Division of Pediatric Emergency Medicine, WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Yu Hsiang Lo
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Andrew Hashikawa
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alexander Rogers
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
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11
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Nadeem S, Manuel MM, Oke OK, Patel V, Filkins LM, Badawy MK, Park JY, Hennes HM. Association of Pyuria with Uropathogens in Young Children. J Pediatr 2022; 245:208-212.e2. [PMID: 35120990 DOI: 10.1016/j.jpeds.2022.01.048] [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: 08/14/2021] [Revised: 01/08/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the association between uropathogens and pyuria in children <24 months of age. STUDY DESIGN A retrospective study of children <24 months of age evaluated in the emergency department for suspected urinary tract infection (UTI) with paired urinalysis and urine culture during a 6-year period. Bagged urine specimens or urine culture growing mixed/multiple urogenital organisms were excluded. Analysis was limited to children with positive urine culture as defined by the American Academy of Pediatrics clinical practice guideline culture thresholds. RESULTS Of 30 462 children, 1916 had microscopic urinalysis and positive urine culture. Urine was obtained by transurethral in-and-out catheterization in 98.3% of cases. Pyuria (≥5 white blood cells per high-powered field) and positive leukocyte esterase (small or more) on the urine dipstick were present in 1690 (88.2%) and 1692 (88.3%) of the children respectively. Children with non-Escherichia coli species were less likely to exhibit microscopic pyuria than children with E coli (OR 0.24, 95% CI 0.17-0.34) with more pronounced effect on Enterococcus and Klebsiella (OR 0.08, 95% CI 0.03-0.18 and OR 0.18, 95% CI 0.11-0.27 respectively). Similarly, positive leukocyte esterase was less frequently seen in non-E coli uropathogens compared with E coli. CONCLUSIONS Pyuria and leukocyte esterase are not sensitive markers to identify non-E coli UTI in young children. More sensitive screening biomarkers are needed to identify UTI with these uropathogens.
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Affiliation(s)
| | - Matthias M Manuel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Vatsal Patel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Laura M Filkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mohamed K Badawy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Halim M Hennes
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
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Kuok CI, Hui WF, Chan WKY. Duplex kidneys and the risk of urinary tract infection in children. World J Pediatr 2022; 18:144-146. [PMID: 34837644 DOI: 10.1007/s12519-021-00491-4] [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: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Chon In Kuok
- Department of Paediatrics, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China.
| | - Wun Fung Hui
- Department of Paediatrics, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
| | - Winnie Kwai Yu Chan
- Department of Paediatrics, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China
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Adu-Oppong B, Thänert R, Wallace MA, Burnham CAD, Dantas G. Substantial overlap between symptomatic and asymptomatic genitourinary microbiota states. MICROBIOME 2022; 10:6. [PMID: 35039079 PMCID: PMC8762997 DOI: 10.1186/s40168-021-01204-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/30/2021] [Indexed: 06/10/2023]
Abstract
BACKGROUND The lack of a definition of urinary microbiome health convolutes diagnosis of urinary tract infections (UTIs), especially when non-traditional uropathogens or paucity of bacteria are recovered from symptomatic patients in routine standard-of-care urine tests. Here, we used shotgun metagenomic sequencing to characterize the microbial composition of asymptomatic volunteers in a set of 30 longitudinally collected urine specimens. Using permutation tests, we established a range of asymptomatic microbiota states, and use these to contextualize the microbiota of 122 urine specimens collected from patients with suspected UTIs diagnostically categorized by standard-of-care urinalysis within that range. Finally, we used a standard-of-care culture protocol to evaluate the efficiency of culture-based recovery of the urinary microbiota. RESULTS The majority of genitourinary microbiota in individals suspected to have UTI overlapped with the spectrum of asymptomatic microbiota states. Longitudinal characterization of the genitourinary microbiome in urine specimens collected from asymptomatic volunteers revealed fluctuations of microbial functions and taxonomy over time. White blood cell counts from urinalysis suggested that urine specimens categorized as 'insignificant', 'contaminated', or 'no-growth' by conventional culture methods frequently showed signs of urinary tract inflammation, but this inflammation is not associated with genitourinary microbiota dysbiosis. Comparison of directly sequenced urine specimens with standard-of-care culturing confirmed that culture-based diagnosis biases genitourinary microbiota recovery towards the traditional uropathogens Escherichia coli and Klebsiella pneumoniae. CONCLUSION Here, we utilize shotgun metagenomic sequencing to establish a baseline of asymptomatic genitourinary microbiota states. Using this baseline we establish substantial overlap between symptomatic and asymptomatic genitourinary microbiota states. Our results establish that bacterial presence alone does not explain the onset of clinical symptoms. Video Abstract.
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Affiliation(s)
- Boahemaa Adu-Oppong
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri USA
| | - Robert Thänert
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri USA
| | - Meghan A. Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri USA
| | - Carey-Ann D. Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri USA
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri USA
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri USA
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri USA
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Lin EMJ, Lay CL, Subramanian GS, Tan WS, Leong SSJ, Moh LCH, Lim K. Control Release Coating for Urinary Catheters with Enhanced Released Profile for Sustained Antimicrobial Protection. ACS APPLIED MATERIALS & INTERFACES 2021; 13:59263-59274. [PMID: 34846837 DOI: 10.1021/acsami.1c17697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Catheter-associated urinary tract infections (CAUTIs) are common and pose significant costs to healthcare systems. To date, this problem is largely unsolved as commercially available antimicrobial catheters are still lacking in functionality and performance. A prior study by Lim et al. ( Biotechnol. Bioeng. 2018, 115 (8), 2000-2012) reported the development of a novel anhydrous polycaprolactone (PCL) polymer formulation with controlled-release functionality for antimicrobial peptides. In this follow-up study, we developed an improved antimicrobial peptide (AMP)-impregnated poly(ethylene glycol) (PEG)-polycaprolactone (PCL) anhydrous polymer coating for enhanced sustained controlled-release functionality to provide catheters with effective antimicrobial properties. Varying the ratio of PEG and PEG-PCL copolymers resulted in polymers with different morphologies, consequently affecting the AMP release profiles. The optimal coating, formulated with 10% (w/w) PEG-PCL in PCL, achieved a controlled AMP release rate of 31.65 ± 6.85 μg/mL daily for up to 19 days, with a moderate initial burst release. Such profile is desired for antimicrobial coating as the initial burst release acts as a sterilizer to kill the bacteria present in the urinary tract upon insertion, and the subsequent linear release functions as a prophylaxis to deter opportunistic microbial infections. As a proof-of-concept application, our optimized coating was then applied to a commercial silicone catheter for further antibacterial tests. Preliminary results revealed that our coated catheters outperformed commercial silver-based antimicrobial catheters in terms of antimicrobial performance and sustainability, lasting for 4 days. Application of the controlled-release coating also aids in retarding biofilm formation, showing a lower extent of biofilm formation at the end of seven inoculation cycles.
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Affiliation(s)
- Esther Marie JieRong Lin
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research, 2 Fusionopolis Way, 138634 Singapore
| | - Chee Leng Lay
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research, 2 Fusionopolis Way, 138634 Singapore
| | - Gomathy Sandhya Subramanian
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research, 2 Fusionopolis Way, 138634 Singapore
- Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research, 31 Biopolis Way, #01-02 Nanos, 138669 Singapore
| | - Wui Siew Tan
- Dornier Medtech Asia Pte Ltd., 2 Venture Drive, Vision Exchange, 608526 Singapore
| | | | - Lionel Chuan Hui Moh
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research, 2 Fusionopolis Way, 138634 Singapore
| | - Kaiyang Lim
- ES-TA Technology Pte Ltd., 21 Jalan Mesin, 368819 Singapore
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15
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Analysis of Indications for Voiding Cystography in Children. J Clin Med 2021; 10:jcm10245809. [PMID: 34945104 PMCID: PMC8705523 DOI: 10.3390/jcm10245809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
In this study, we report the experience of our center with the prognosis of vesicoureteral reflux, depending on the indications for voiding cystography, during a 12-year period. Retrospective analysis included 4302 children who were analyzed according to the indication for voiding cystography: (1) a febrile urinary tract infection, (2) urinary tract malformations on ultrasonography and (3) lower urinary tract dysfunction. Vesicoureteral reflux was found in 917 patients (21.32%; 24.1% of girls and 17.9% of boys). In group (1), reflux was found in 437/1849 cases (23.63%), group (2) in 324/1388 cases (23.34%) and group (3) in 156/1065 cases (14.65%). A significantly lower prevalence of reflux and its lower degree was found in children from group (3) when compared to other groups (p < 0.01). VURs were confirmed in over 20% of children with urinary tract malformations on ultrasonography or after a febrile urinary tract infection, suggesting the need for voiding cystography in these children. Indications for this examination in children with lower urinary tract dysfunction should be limited.
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16
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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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Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O'Leary ST, Okechukwu K, Woods CR. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics 2021; 148:peds.2021-052228. [PMID: 34281996 DOI: 10.1542/peds.2021-052228] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This guideline addresses the evaluation and management of well-appearing, term infants, 8 to 60 days of age, with fever ≥38.0°C. Exclusions are noted. After a commissioned evidence-based review by the Agency for Healthcare Research and Quality, an additional extensive and ongoing review of the literature, and supplemental data from published, peer-reviewed studies provided by active investigators, 21 key action statements were derived. For each key action statement, the quality of evidence and benefit-harm relationship were assessed and graded to determine the strength of recommendations. When appropriate, parents' values and preferences should be incorporated as part of shared decision-making. For diagnostic testing, the committee has attempted to develop numbers needed to test, and for antimicrobial administration, the committee provided numbers needed to treat. Three algorithms summarize the recommendations for infants 8 to 21 days of age, 22 to 28 days of age, and 29 to 60 days of age. The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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Affiliation(s)
- Robert H Pantell
- Department of Pediatrics, School of Medicine, University of California San Francisco, San Francisco, California
| | - Kenneth B Roberts
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William G Adams
- Boston Medical Center/Boston University School of Medicine, Deparment of Pediatrics, Boston, Massachusetts
| | - Benard P Dreyer
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | - Nathan Kuppermann
- Department of Emergency Medicine and Pediatric, School of Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Velasco R, Lejarzegi A, Gomez B, de la Torre M, Duran I, Camara A, de la Rosa D, Manzano S, Rodriguez J, González A, Lopes AA, Rivas A, Martinez I, Angelats CM, Moya S, Corral S, Alonso J, Del Rio P, Sancho E, Ruiz Del Olmo I, Nieto I, Vega B, Mintegi S. Febrile young infants with abnormal urine dipstick at low risk of invasive bacterial infection. Arch Dis Child 2021; 106:758-763. [PMID: 33246922 DOI: 10.1136/archdischild-2020-320468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop and validate a prediction rule to identify well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of invasive bacterial infections (IBIs, bacteraemia or bacterial meningitis). DESIGN Ambispective, multicentre study. SETTING The derivation set in a single paediatric emergency department (ED) between 2003 and 2017. The validation set in 21 European EDs between December 2017 and November 2019. PATIENTS Two sets of well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick (either leucocyte esterase and/or nitrite positive test). MAIN OUTCOME Prevalence of IBI in low-risk infants according to the RISeuP score. RESULTS We included 662 infants in the derivation set (IBI rate:5.2%). After logistic regression, we developed a score (RISeuP score) including age (≤15 days old), serum procalcitonin (≥0.6 ng/mL) and C reactive protein (≥20 mg/L) as risk factors. The absence of any risk factor had a sensitivity of 96.0% (95% CI 80.5% to 99.3%), a negative predictive value of 99.4% (95% CI 96.4% to 99.9%) and a specificity of 32.9% (95% CI 28.8% to 37.3%) for ruling out an IBI. Applying it in the 449 infants of the validation set (IBI rate 4.9%), sensitivity, negative predictive value and specificity were 100% (95% CI 87.1% to 100%), 100% (95% CI 97.3% to 100%) and 29.7% (95% CI 25.8% to 33.8%), respectively. CONCLUSION This prediction rule accurately identified well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of IBI. This score can be used to guide initial clinical decision-making in these patients, selecting infants suitable for an outpatient management.
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Affiliation(s)
- Roberto Velasco
- Pediatric Emergency Unit, Rio Hortega University Hospital, Valladolid, Spain
| | - Ainara Lejarzegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces. University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Borja Gomez
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces. University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Mercedes de la Torre
- Pediatric Emergency Department, Hospital Infantil Universitario Nino Jesus, Madrid, Madrid, Spain
| | - Isabel Duran
- Pediatric Emergency Department, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Amaia Camara
- Pediatric Emergency Department, Donostia Ospitalea, Donostia, Spain
| | - Daniel de la Rosa
- Pediatric Emergency Department, Hospital Universitario Materno Infantil de Canarias, Las Palmas Gran Canaria, Spain
| | - Sergio Manzano
- Pediatric Emergency Department, Geneva University Hospital, Geneva, Switzerland
| | - Jose Rodriguez
- Pediatrics, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | - Anne-Aurelie Lopes
- Pediatric Emergency Department, Robert-Debré Mother-Child University Hospital. Sorbonne University, Paris, France
| | - Aristides Rivas
- Pediatric Emergency Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Isabel Martinez
- Pediatric Emergency Department, Virgen del Rocio University Hospital, Sevilla, Spain
| | | | - Sandra Moya
- Pediatric Emergency Department, Parc Taulí University Hospital, Sabadell, Spain
| | - Sonia Corral
- Pediatrics, Granollers General Hospital, Granollers, Spain
| | - Juan Alonso
- Pediatrics, Hospital San Agustín, Linares, Spain
| | | | - Elena Sancho
- Pediatrics, Hospital de San Jorge, Huesca, Spain
| | | | - Inmaculada Nieto
- Pediatrics, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain
| | - Beatriz Vega
- Pediatrics, Hospital Comarcal de Laredo, Laredo, Spain
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces. University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
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19
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Pragmatic evaluation of a midstream urine collection technique for infants in the emergency department. CAN J EMERG MED 2021; 22:665-672. [PMID: 32383423 DOI: 10.1017/cem.2020.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Our objective was to examine the performance characteristics of a bladder stimulation technique for urine collection among infants presenting to the emergency department (ED). METHODS This prospective cohort study enrolled a convenience sample of infants aged ≤ 90 days requiring urine testing in the ED. Infants were excluded if critically ill, moderately to severely dehydrated, or having significant feeding issues. Bladder stimulation consisted of finger tapping on the lower abdomen with or without lower back massage while holding the child upright. The primary outcome was successful midstream urine collection within 5 minutes of stimulation. Secondary outcomes included sample contamination, bladder stimulation time for successful urine collection, and perceived patient distress on a 100-mm visual analog scale (VAS). RESULTS We enrolled 151 infants and included 147 in the analysis. Median age was 53 days (interquartile range [IQR] 27-68 days). Midstream urine sample collection using bladder stimulation was successful in 78 infants (53.1%; 95% confidence interval [CI] 45-60.9). Thirty-nine samples (50%) were contaminated. Most contaminated samples (n = 31; 79.5%) were reported as "no significant growth" or "growth of 3 or more organisms". Median bladder stimulation time required for midstream urine collection was 45 seconds (IQR 20-120 seconds). Mean VAS for infant distress was 22 mm (standard deviation 23 mm). CONCLUSIONS The success rate of this bladder stimulation technique was lower than previously reported. The contamination rate was high, however most contaminated specimens were easily identified and had no clinical impact.
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Albarrak M, Alzomor O, Almaghrabi R, Alsubaie S, Alghamdi F, Bajouda A, Nojoom M, Faqeehi H, Rubeea SA, Alnafeesah R, Dolgum S, ALghoshimi M, AlHajjar S, AlShahrani D. Diagnosis and management of community-acquired urinary tract infection in infants and children: Clinical guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS). Int J Pediatr Adolesc Med 2021; 8:57-67. [PMID: 34084874 PMCID: PMC8144855 DOI: 10.1016/j.ijpam.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 10/25/2022]
Abstract
Urinary tract infection (UTI) is the most common bacterial disease in childhood worldwide and may have significant adverse consequences, particularly for young children. In this guideline, we provide the most up-to-date information for the diagnosis and management of community-acquired UTI in infants and children aged over 90 days up to 14 years. The current recommendations given by the American Academy of Pediatrics Practice guidelines, Canadian Pediatric Society guideline, and other international guidelines are considered as well as regional variations in susceptibility patterns and resources. This guideline covers the diagnosis, therapeutic options, and prophylaxis for the management of community-acquired UTI in children guided by our local antimicrobial resistance pattern of the most frequent urinary pathogens. Neonates, infants younger than three months, immunocompromised patients, children recurrent UTIs, or renal abnormalities should be managed individually because these patients may require more extensive investigation and more aggressive therapy and follow up, so it is considered out of the scope of these guidelines. Establishment of children-specific guidelines for the diagnosis and management of community-acquired UTI can reduce morbidity and mortality. We present a clinical statement from the Saudi Pediatric Infectious Diseases Society (SPIDS), which concerns the diagnosis and management of community-acquired UTI in children.
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Affiliation(s)
- May Albarrak
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omar Alzomor
- Pediatric Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rana Almaghrabi
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sarah Alsubaie
- Department of Pediatrics, College of medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Faisal Alghamdi
- Pediatric Emergency, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
- Pediatric Radiology, Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Asrar Bajouda
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maha Nojoom
- Pediatric Radiology, Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hassan Faqeehi
- Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Subhy Abo Rubeea
- Pediatric Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Razan Alnafeesah
- General Pediatric Department, Alyammamh Hospital, Riyadh, Saudi Arabia
| | - Saeed Dolgum
- Pediatric Infectious Diseases, Dr.Suliman ALhabib Hospital, Riyadh, Saudi Arabia
| | - Mohammed ALghoshimi
- General Pediatrics Department, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sami AlHajjar
- Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Dayel AlShahrani
- Pediatric Infectious Diseases, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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21
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Burstein B, Sabhaney V, Bone JN, Doan Q, Mansouri FF, Meckler GD. Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e214544. [PMID: 33978724 PMCID: PMC8116985 DOI: 10.1001/jamanetworkopen.2021.4544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Fever in the first months of life remains one of the most common pediatric problems. Urinary tract infections are the most frequent serious bacterial infections in this population. All published guidelines and quality initiatives for febrile young infants recommend lumbar puncture (LP) and cerebrospinal fluid (CSF) testing on the basis of a positive urinalysis result to exclude bacterial meningitis as a cause. For well infants older than 28 days with an abnormal urinalysis result, LP remains controversial. OBJECTIVE To assess the prevalence of bacterial meningitis among febrile infants 29 to 60 days of age with a positive urinalysis result to evaluate whether LP is routinely required. DATA SOURCES MEDLINE and Embase were searched for articles published from January 1, 2000, to July 25, 2018, with deliberate limitation to recent studies. Before analysis, the search was repeated (October 6, 2019) to ensure that new studies were included. STUDY SELECTION Studies that reported on healthy, full-term, well-appearing febrile infants 29 to 60 days of age for whom patient-level data could be ascertained for urinalysis results and meningitis status were included. DATA EXTRACTION AND SYNTHESIS Data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the Newcastle-Ottawa Scale to assess bias. Pooled prevalences and odds ratios (ORs) were estimated using random-effect models. MAIN OUTCOMES AND MEASURES The primary outcome was the prevalence of culture-proven bacterial meningitis among infants with positive urinalysis results. The secondary outcome was the prevalence of bacterial meningitis, defined by CSF testing or suggestive history at clinical follow-up. RESULTS The parent search yielded 3227 records; 48 studies were included (17 distinct data sets of 25 374 infants). The prevalence of culture-proven meningitis was 0.44% (95% CI, 0.25%-0.78%) among 2703 infants with positive urinalysis results compared with 0.50% (95% CI, 0.33%-0.76%) among 10 032 infants with negative urinalysis results (OR, 0.74; 95% CI, 0.39-1.38). The prevalence of bacterial meningitis was 0.25% (95% CI, 0.14%-0.45%) among 4737 infants with meningitis status ascertained by CSF testing or clinical follow-up and 0.28% (95% CI, 0.21%-0.36%) among 20 637 infants with positive and negative urinalysis results (OR, 0.89; 95% CI, 0.48-1.68). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, the prevalence of bacterial meningitis in well-appearing febrile infants 29 to 60 days of age with positive urinalysis results ranged from 0.25% to 0.44% and was not higher than that in infants with negative urinalysis results. These results suggest that for these infants, the decision to use LP should not be guided by urinalysis results alone.
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Affiliation(s)
- Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Vikram Sabhaney
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey N. Bone
- Department Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fahad F. Mansouri
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Garth D. Meckler
- Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Mattoo TK, Shaikh N, Nelson CP. Contemporary Management of Urinary Tract Infection in Children. Pediatrics 2021; 147:peds.2020-012138. [PMID: 33479164 DOI: 10.1542/peds.2020-012138] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
Urinary tract infection (UTI) is common in children, and girls are at a significantly higher risk, as compared to boys, except in early infancy. Most cases are caused by Escherichia coli Collection of an uncontaminated urine specimen is essential for accurate diagnosis. Oral antibiotic therapy for 7 to 10 days is adequate for uncomplicated cases that respond well to the treatment. A renal ultrasound examination is advised in all young children with first febrile UTI and in older children with recurrent UTI. Most children with first febrile UTI do not need a voiding cystourethrogram; it may be considered after the first UTI in children with abnormal renal and bladder ultrasound examination or a UTI caused by atypical pathogen, complex clinical course, or known renal scarring. Long-term antibiotic prophylaxis is used selectively in high-risk patients. Few patients diagnosed with vesicoureteral reflux after a UTI need surgical correction. The most consequential long-term complication of acute pyelonephritis is renal scarring, which may increase the risk of hypertension or chronic kidney disease later in life. Treatment of acute pyelonephritis with an appropriate antibiotic within 48 hours of fever onset and prevention of recurrent UTI lowers the risk of renal scarring. Pathogens causing UTI are increasingly becoming resistant to commonly used antibiotics, and their indiscriminate use in doubtful cases of UTI must be discouraged.
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Affiliation(s)
- Tej K Mattoo
- Division of Pediatric Nephrology, Departments of Pediatrics and Urology, Wayne State University School of Medicine and Wayne Pediatrics, Detroit, Michigan;
| | - Nader Shaikh
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital and Department of Surgery, Harvard Medical School, Harvard University, Boston, Massachusetts
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Zgheib H, Zakhem AE, Wakil C, Cheaito MA, Cheaito R, Finianos A, Chebl RB, Kaddoura R, Souky NA, Majzoub IE. Role of urine studies in asymptomatic febrile neutropenic patients presenting to the emergency department. World J Emerg Med 2021; 12:99-104. [PMID: 33728001 DOI: 10.5847/wjem.j.1920-8642.2021.02.003] [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: 11/19/2022] Open
Abstract
BACKGROUND The role of urine studies in the detection of urinary tract infection (UTI) in febrile neutropenic patients with urinary symptoms (having a urinary catheter or having a positive urine analysis) is inarguable. However, the evidence is scarce regarding the indication for urine studies in asymptomatic (i.e., without urinary symptoms) patients with febrile neutropenia (FN) presenting to the emergency department (ED). The aim of this study is to evaluate the need for obtaining urine studies in asymptomatic febrile neutropenic patients. METHODS This was a retrospective cohort study conducted on adult cancer patients who presented to the ED with FN and had no urinary symptoms. We included all ED presentations of eligible patients between January 2013 and September 2018. Student's t-test and Wilcoxon rank-sum test were used for continuous data, while Chi-square and Fisher's exact tests were used for categorical data. Participants were divided into two groups based on their urine culture (UC) results: negative and positive UCs. Two cut-offs were used for positive UC results: ≥105 cfu/mL and ≥104 cfu/mL. RESULTS We included 284 patients in our study. The age of our patient population was 48.5±18.5 years. More than two-thirds (68.7%) of patients had severe neutropenia, while only 3.9% and 9.9% of the patients had positive UCs at ≥105 cfu/mL and ≥104 cfu/mL, respectively. UCs were expectedly positive in most patients with urinalysis (UA) abnormalities. However, 27.3% and 32.1% of patients with positive UCs at ≥105 cfu/mL and ≥104 cfu/mL respectively had a normal UA. CONCLUSIONS In our study, the incidence of UTI in adult febrile neutropenic cancer patients who present to the ED without urinary symptoms is low. Consequently, routine urine testing may not be warranted in this population, as it adds unnecessary financial burdens on the patients and delays timely management.
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Affiliation(s)
- Hady Zgheib
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Aline El Zakhem
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Cynthia Wakil
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Mohamad Ali Cheaito
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Rola Cheaito
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Antoine Finianos
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Rima Kaddoura
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Nader Al Souky
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Imad El Majzoub
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
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24
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Maldonado J, Estévez MC, Fernández-Gavela A, González-López JJ, González-Guerrero AB, Lechuga LM. Label-free detection of nosocomial bacteria using a nanophotonic interferometric biosensor. Analyst 2020; 145:497-506. [PMID: 31750459 DOI: 10.1039/c9an01485c] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Nosocomial infections are a major concern at the worldwide level. Early and accurate identification of nosocomial pathogens is crucial to provide timely and adequate treatment. A prompt response also prevents the progression of the infection to life-threatening conditions, such as septicemia or generalized bloodstream infection. We have implemented two highly sensitive methodologies using an ultrasensitive photonic biosensor based on a bimodal waveguide interferometer (BiMW) for the fast detection of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA), two of the most prevalent bacteria associated with nosocomial infections. For that, we have developed a biofunctionalization strategy based on the use of a PEGylated silane (silane-PEG-COOH) which provides a highly resistant and bacteria-repelling surface, which is crucial to specifically detect each bacterium. Two different biosensor assays have been set under standard buffer conditions: one based on a specific direct immunoassay employing polyclonal antibodies for the detection of P. aeruginosa and another one employing aptamers for the direct detection of MRSA. The biosensor immunoassay for P. aeruginosa is fast (it only takes 12 min) and specific and has experimentally detected concentrations down to 800 cfu mL-1 (cfu: colony forming unit). The second one relies on the use of an aptamer that specifically detects penicillin-binding protein 2a (PBP2a), a protein only expressed in the MRSA mutant, providing a photonic biosensor with the ability to identify the resistant pathogen MRSA and differentiate it from methicillin-susceptible S. aureus (MSSA). Direct, label-free, and selective detection of whole MRSA bacteria has been achieved, making possible the direct detection of also 800 cfu mL-1. According to the signal-to-noise (S/N) ratio of the device, a theoretical limit of detection (LOD) of around 49 and 29 cfu mL-1 was estimated for P. aeruginosa and MRSA, respectively. Both results obtained under standard conditions reveal the great potential this interferometric biosensor device has as a versatile and specific tool for bacterial detection and quantification, providing a rapid method for the identification of nosocomial pathogens within the clinical requirements of sensitivity for the diagnosis of infections.
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Affiliation(s)
- Jesús Maldonado
- Nanobiosensors and Bioanalytical Applications Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, CIBER-BBN, and BIST, Campus UAB, 08193 Bellaterra, Barcelona, Spain.
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25
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Affiliation(s)
- Rachel H Kowalsky
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Department of Pediatrics, New York Presbyterian Hospital-Weill Cornell Medicine, New York.,Cornell Center for Health Equity, New York, New York
| | - Ashley C Rondini
- Department of Sociology, Franklin & Marshall College, Lancaster, Pennsylvania
| | - Shari L Platt
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Department of Pediatrics, New York Presbyterian Hospital-Weill Cornell Medicine, New York
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26
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Tullus K, Shaikh N. Urinary tract infections in children. Lancet 2020; 395:1659-1668. [PMID: 32446408 DOI: 10.1016/s0140-6736(20)30676-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 02/27/2020] [Accepted: 03/13/2020] [Indexed: 01/03/2023]
Abstract
Urinary tract infections (UTIs) in children are among the most common bacterial infections in childhood. They are equally common in boys and girls during the first year of life and become more common in girls after the first year of life. Dividing UTIs into three categories; febrile upper UTI (acute pyelonephritis), lower UTI (cystitis), and asymptomatic bacteriuria, is useful for numerous reasons, mainly because it helps to understand the pathophysiology of the infection. A single episode of febrile UTI is often caused by a virulent Escherichia coli strain, whereas recurrent infections and asymptomatic bacteriuria commonly result from urinary tract malformations or bladder disturbances. Treatment of an upper UTI needs to be broad and last for 10 days, a lower UTI only needs to be treated for 3 days, often with a narrow-spectrum antibiotic, and asymptomatic bacteriuria is best left untreated. Investigations of atypical and recurrent episodes of febrile UTI should focus on urinary tract abnormalities, whereas in cases of cystitis and asymptomatic bacteriuria the focus should be on bladder function.
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Affiliation(s)
- Kjell Tullus
- Renal Unit, Great Ormond Street Hospital for Children, London, UK.
| | - Nader Shaikh
- Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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27
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Ammenti A, Alberici I, Brugnara M, Chimenz R, Guarino S, La Manna A, La Scola C, Maringhini S, Marra G, Materassi M, Morello W, Nicolini G, Pennesi M, Pisanello L, Pugliese F, Scozzola F, Sica F, Toffolo A, Montini G. Updated Italian recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children. Acta Paediatr 2020; 109:236-247. [PMID: 31454101 PMCID: PMC7004047 DOI: 10.1111/apa.14988] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022]
Abstract
AIM Our aim was to update the recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children, which were endorsed in 2012 by the Italian Society of Pediatric Nephrology. METHODS The Italian recommendations were revised on the basis of a review of the literature published from 2012 to October 2018. We also carried out an ad hoc evaluation of the risk factors to identify children with high-grade vesicoureteral reflux or renal scarring, which were published in the previous recommendations. When evidence was not available, the working group held extensive discussions, during various meetings and through email exchanges. RESULTS Four major modifications have been introduced. The method for collecting urine for culture and its interpretation has been re-evaluated. We have reformulated the algorithm that guides clinical decisions to proceed with voiding cystourethrography. The suggested antibiotics have been revised, and we have recommended further restrictions of the use of antibiotic prophylaxis. CONCLUSION These updated recommendations have now been endorsed by the Italian Society of Pediatric Nephrology and the Italian Society for Pediatric Infectivology. They can also be used to compare other recommendations that are available, as a worldwide consensus in this area is still lacking.
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Affiliation(s)
- Anita Ammenti
- Pediatric Polyspecialistic GroupPoliambulatorio Medi‐SaluserParmaItaly
| | - Irene Alberici
- Department of Woman and Child's HealthUniversity of PadovaPadovaItaly
| | | | - Roberto Chimenz
- Pediatric Nephrology and Dialysis UnitDepartment of PediatricsG. Martino HospitalUniversity of MessinaMessinaItaly
| | - Stefano Guarino
- Department of WomanChild and of General and Specialized SurgeryUniversità degli Studi della Campania L. VanvitelliNaplesItaly
| | - Angela La Manna
- Department of WomanChild and of General and Specialized SurgeryUniversità degli Studi della Campania L. VanvitelliNaplesItaly
| | - Claudio La Scola
- Nephrology and Dialysis UnitDepartment of PediatricsAzienda Ospedaliero Universitaria Sant'Orsola‐MalpighiBolognaItaly
| | | | - Giuseppina Marra
- Pediatric NephrologyDialysis and Transplant UnitFondazione Ca'Granda, IRCCS Policlinico di MilanoMilanoItaly
| | | | - William Morello
- Pediatric NephrologyDialysis and Transplant UnitFondazione Ca'Granda, IRCCS Policlinico di MilanoMilanoItaly
| | | | - Marco Pennesi
- Department of PediatricsInstitute for Child and Maternal HealthIRCCS Burlo GarofoloTriesteItaly
| | | | | | | | | | | | - Giovanni Montini
- Pediatric NephrologyDialysis and Transplant UnitFondazione Ca'Granda, IRCCS Policlinico di MilanoMilanoItaly
- Giuliana and Bernardo Caprotti Chair of PediatricsDepartment of Clinical Sciences and Community HealthUniversity of MilanoMilanoItaly
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28
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Behzadi P, Urbán E, Matuz M, Benkő R, Gajdács M. The Role of Gram-Negative Bacteria in Urinary Tract Infections: Current Concepts and Therapeutic Options. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1323:35-69. [PMID: 32596751 DOI: 10.1007/5584_2020_566] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Urinary tract infections (UTIs) are some of the most common infections in human medicine worldwide, recognized as an important public health concern to healthcare systems around the globe. In addition, urine specimens are one of the most frequently submitted samples for culture to the clinical microbiology laboratory, exceeding the number of most of the other sample types. The epidemiology, species-distribution and susceptibility-patterns of uropathogens vary greatly in a geographical and time-dependent manner and it also strongly correlated with the reported patient population studied. Nevertheless, many studies highlight the fact that the etiological agents in UTIs have changed considerably, both in nosocomial and community settings, with a shift towards "less common" microorganisms having more pronounced roles. There is increasing demand for further research to advance diagnostics and treatment options, and to improve care of the patients. The aim of this review paper was to summarize current developments in the global burden of UTI, the diagnostic aspects of these infectious pathologies, the possible etiological agents and their virulence determinants (with a special focus on the members of the Enterobacterales order), current guidelines and quality indicators in the therapy of UTIs and the emergence of multidrug resistance in urinary pathogens.
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Affiliation(s)
- Payam Behzadi
- Department of Microbiology, College of Basic Sciences Islamic Azad University, Tehran, Iran
| | - Edit Urbán
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Institute of Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary.,Central Pharmacy Service, Emergency Department, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Márió Gajdács
- Institute of Medical Microbiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary. .,Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary.
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29
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Kim SH. Is there a simple and less invasive way to accurately diagnose acute pyelonephritis? KOREAN JOURNAL OF PEDIATRICS 2019; 62:442-443. [PMID: 31870085 PMCID: PMC6933306 DOI: 10.3345/kjp.2019.01186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/15/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Seong Heon Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
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30
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Cho B, Lee SH, Song J, Bhattacharjee S, Feng J, Hong S, Song M, Kim W, Lee J, Bang D, Wang B, Riley LW, Lee LP. Nanophotonic Cell Lysis and Polymerase Chain Reaction with Gravity-Driven Cell Enrichment for Rapid Detection of Pathogens. ACS NANO 2019; 13:13866-13874. [PMID: 31756079 DOI: 10.1021/acsnano.9b04685] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Rapid and precise detection of pathogens is a critical step in the prevention and identification of emergencies related to health and biosafety as well as the clinical management of community-acquired urinary tract infections or sexually transmitted diseases. However, a conventional culture-based pathogen diagnostic method is time-consuming, permitting physicians to use antibiotics without ample clinical data. Here, we present a nanophotonic Light-driven Integrated cell lysis and polymerase chain reaction (PCR) on a chip with Gravity-driven cell enrichment Health Technology (LIGHT) for rapid precision detection of pathogens (<20 min). We created the LIGHT, which has the three functions of (1) selective enrichment of pathogens, (2) photothermal cell lysis, and (3) photonic PCR on a chip. We designed the gravity-driven cell enrichment via a nanoporous membrane on a chip that allows an effective bacterial enrichment of 40 000-fold from a 1 mL sample in 2 min. We established a light-driven photothermal lysis of preconcentrated bacteria within 1 min by designing the network of nanoplasmonic optical antenna on a chip for ultrafast light-to-heat conversion, created the nanoplasmonic optical antenna network-based ultrafast photonic PCR on a chip, and identified Escherichia coli. Finally, we demonstrated the end-point detection of up to 103 CFU/mL of E. coli in 10 min. We believe that our nanophotonic LIGHT will provide rapid and precise identification of pathogens in both developing and developed countries.
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Affiliation(s)
- Byungrae Cho
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
- UC Berkeley and UCSF Joint Graduate Program in Bioengineering , University of California , Berkeley , California 94720 , United States
- Berkeley Sensor and Actuator Center , University of California , Berkeley , California 94720 , United States
| | - Sang Hun Lee
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
- Berkeley Sensor and Actuator Center , University of California , Berkeley , California 94720 , United States
| | - Jihwan Song
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
| | - Saptati Bhattacharjee
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
| | - Jeffrey Feng
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
| | - SoonGweon Hong
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
- Berkeley Sensor and Actuator Center , University of California , Berkeley , California 94720 , United States
| | - Minsun Song
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
- UC Berkeley and UCSF Joint Graduate Program in Bioengineering , University of California , Berkeley , California 94720 , United States
- Berkeley Sensor and Actuator Center , University of California , Berkeley , California 94720 , United States
| | - Wonseok Kim
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
- Berkeley Sensor and Actuator Center , University of California , Berkeley , California 94720 , United States
| | - Jonghwan Lee
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
- Berkeley Sensor and Actuator Center , University of California , Berkeley , California 94720 , United States
| | - Doyeon Bang
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
- Berkeley Sensor and Actuator Center , University of California , Berkeley , California 94720 , United States
| | - Bowen Wang
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
| | - Lee W Riley
- Division of Infectious Disease and Vaccinology, School of Public Health , University of California , Berkeley , California 94720 , United States
| | - Luke P Lee
- Department of Bioengineering , University of California , Berkeley , California 94720 , United States
- UC Berkeley and UCSF Joint Graduate Program in Bioengineering , University of California , Berkeley , California 94720 , United States
- Berkeley Sensor and Actuator Center , University of California , Berkeley , California 94720 , United States
- Department of Electrical Engineering and Computer Science , University of California , Berkeley , California 94720 , United States
- Biophysics Graduate Program , University of California , Berkeley , California 94720 , United States
- Biomedical Institute for Global Health Research and Technology (BIGHEART), Yong Loo Lin School of Medicine and Faculty of Engineering , National University of Singapore , Singapore 119077
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31
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The Effectiveness of Dipstick for the Detection of Urinary Tract Infection. CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2019; 2019:8642628. [PMID: 31781317 PMCID: PMC6855063 DOI: 10.1155/2019/8642628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022]
Abstract
Background The balance between the choices of UTI diagnostic tools in most primary care settings has been settled for by the more rapid, less labour-intensive dipstick. This study aimed to evaluate the effectiveness of dipstick for diagnosing UTI. Method A total of 429 urine samples were collected from patients suspected of UTI; cultured on cysteine-lactose-electrolyte-deficient (CLED) agar, blood agar, and MacConkey agar; and incubated at 37°C overnight. Urine cultures with bacteria count ≥105 cfu/ml were classified as “positive” for UTI. A dipstick was used to screen for the production of nitrite (NIT) and leucocyte esterase (LE), following the manufacturer's instructions. Biochemical reactions of nitrite and leucocyte esterase > “trace” were classified as “positive.” A quantitative urine culture was used as the gold standard. Results The highest sensitivity value and negative predictive value were recorded for the combined “NIT+ or LE+” dipstick results. The highest specificity value, positive predictive value, positive likelihood ratio, and negative likelihood ratio were recorded for “nitrite-positive and leucocyte esterase-positive” results. Combined “nitrite-positive or leucocyte-positive” result was relatively the best indicator for accurate dipstick diagnosis, with AUC = 0.7242. Cohen's kappa values between dipstick diagnosis and quantitative culture were <0.6. Conclusion Combined performance of nitrite and leucocyte esterase results appeared better than the solo performance of nitrite and leucocyte esterase. However, little confidence should be placed on dipstick diagnosis; hence, request for quantity culture should be encouraged in the primary healthcare settings.
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Piñeiro Pérez R, Cilleruelo Ortega MJ, Ares Álvarez J, Baquero-Artigao F, Silva Rico JC, Velasco Zúñiga R, Martínez Campos L, Carazo Gallego B, Conejo Fernández AJ, Calvo C, Alfayate Miguélez S, Berghezan Suárez A, García Vera C, José García García J, Herreros M, Rodrigo Gonzalo de Liria C. Recomendaciones sobre el diagnóstico y tratamiento de la infección urinaria. An Pediatr (Barc) 2019; 90:400.e1-400.e9. [DOI: 10.1016/j.anpedi.2019.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022] Open
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Piñeiro Pérez R, Cilleruelo Ortega MJ, Ares Álvarez J, Baquero-Artigao F, Silva Rico JC, Velasco Zúñiga R, Martínez Campos L, Carazo Gallego B, Conejo Fernández AJ, Calvo C, Alfayate Miguélez S, Berghezan Suárez A, García Vera C, José García García J, Herreros M, Rodrigo Gonzalo de Liria C. Recommendations on the diagnosis and treatment of urinary tract infection. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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34
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Arlen AM, Cooper CS. New trends in voiding cystourethrography and vesicoureteral reflux: Who, when and how? Int J Urol 2019; 26:440-445. [PMID: 30762254 DOI: 10.1111/iju.13915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/06/2019] [Indexed: 12/01/2022]
Abstract
Vesicoureteral reflux, retrograde flow of urine from the bladder into the upper urinary tract, is one of the most common urological diagnoses in the pediatric population. Diagnosis and subsequent management of urinary reflux have become increasingly debated in the past decade, with divergent opinions over which patients should be evaluated for reflux, and when detected, which children should receive intervention. Although some argue that vesicoureteral reflux is a "phenotype" that often resolves without intervention, others contest that untreated reflux has the potential to cause irreversible renal damage over time. Voiding cystourethrogram images the urethra and bladder during both bladder filling and emptying, as well as the ureters and kidneys when reflux is present, and is considered the gold standard for diagnosing vesicoureteral reflux. Once detected, therapeutic options for urinary reflux are diverse, ranging from observation with or without low-dose antibiotic prophylaxis to a variety of operative interventions. Management should be based on a multitude of factors including patient age, risk of subsequent urinary tract infections, risk of renal parenchymal injury, a given child's projected clinical course and parental preference. Over the past two decades, investigators have elucidated many crucial voiding cystourethrogram findings in addition to grade that provide significant prognostic information and are useful in determining the best course of action for a child on a more individualized basis.
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Affiliation(s)
- Angela M Arlen
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher S Cooper
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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