Does this child have urinary tract infection? JAMA 298:  2895-2904

Author(s): Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, et al.

Abstract

Objective To review the diagnostic accuracy of symptoms and signs for the diagnosis of UTI in infants and children.

Data Sources A search of MEDLINE and EMBASE databases was conducted for articles published between 1966 and October 2007, as well as a manual review of bibliographies of all articles meeting inclusion criteria, 1 previously published systematic review, 3 clinical skills textbooks, and 2 experts in the field, yielding 6988 potentially relevant articles.

Study Selection Studies were included if they contained data on signs or symptoms of UTI in children through age 18 years. Of 337 articles examined, 12 met all inclusion criteria.

Data Extraction Two evaluators independently reviewed, rated, and abstracted data from each article.

Data Synthesis In infants with fever, history of a previous UTI (likelihood ratio [LR] range, 2.3-2.9), temperature higher than 40°C (LR range, 3.2-3.3), and suprapubic tenderness (LR, 4.4; 95% confidence interval [CI], 1.6-12.4) were the findings most useful for identifying those with a UTI. Among male infants, lack of circumcision increased the likelihood of a UTI (summary LR, 2.8; 95% CI, 1.9-4.3); and the presence of circumcision was the only finding with an LR of less than 0.5 (summary LR, 0.33; 95% CI, 0.18-0.63). Combinations of findings were more useful than individual findings in identifying infants with a UTI (for temperature >39°C for >48 hours without another potential source for fever on examination, the LR for all findings present was 4.0; 95% CI, 1.2-13.0; and for temperature <39°C with another source for fever, the LR was 0.37; 95% CI, 0.16-0.85). In verbal children, abdominal pain (LR, 6.3; 95% CI, 2.5-16.0), back pain (LR, 3.6; 95% CI, 2.1-6.1), dysuria, frequency, or both (LR range, 2.2-2.8), and new-onset urinary incontinence (LR, 4.6; 95% CI, 2.8-7.6) increased the likelihood of a UTI.

Conclusions Although individual signs and symptoms were helpful in the diagnosis of a UTI, they were not sufficiently accurate to definitively diagnose UTIs. Combination of findings can identify infants with a low likelihood of a UTI.

Similar Articles

Prevalence of urinary tract infection in childhood: A meta-analysis

Author(s): Shaikh N, Morone NE, Bost JE, Farrell MH

The changing epidemiology of serious bacterial infections in young infants

Author(s): Greenhow TL, Hung YY, Herz AM, Losada E, Pantell RH

Prevalence of urinary tract infection in childhood: A meta-analysis

Author(s): Sheikh N, Morone NE, Bost JE, Farerell MH

  Improving antibiotic prescribing for pediatric urinary tract infections in outpatient settings

Author(s): Matthew F. Daley, Sharisse M, Arnold R, Karen A, Glenn Liza M, et al.

The importance of gender stratified antibiotic resistance surveillance study

Author(s): den Heijer CD, Penders J, Donker GA, Bruggeman CA Bruggeman CA, et al.

Antibiotic resistance patterns of outpatient pediatric urinary tract infections

Author(s): Edlin RS, Shapiro DJ, Hersh AL, Copper HL