Objective:

Urinary tract infections (UTI) are one of the most common bacterial infections in children. Urine culture (UC) is the reference test for the diagnosis of UTI. Being a lengthy examination, the decision to initiate an antibiotic is based on clinical indicators and urine dipstick screening test (UDST). Management of UTI in the child or adolescent may be carried out by the family doctor. The aim of this study was to evaluate the efficacy of UDST in the early diagnosis of UTI in pediatric age.

Methods:

An observational study was carried out. It included patients (0-18 years) who went to the pediatric emergency department between 01/01/2015 and 12/31/2016 and underwent urine collection for ASU and UC. ASU results were analyzed and compared with UC results. A definitive diagnosis of UTI was assigned to all patients with positive UC. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and odds ratio (OR) of the nitrite and leukocyte esterase (LE) parameters for the diagnosis of UTI were determined.

Results:

Of the 3,400 samples included, 21.2% had a positive bacteriological result. The most common microorganism was Escherichia coli. Nitrites showed a sensitivity of 28% and a specificity of 99% for the diagnosis of UTI. LE revealed a 90% sensitivity and 63% specificity. For both, sensitivity was 27% and specificity 99%, with PPV of 91% and NPV of 83%. LE was greater than 500 cells/mcl had a 93% specificity. In the 0-12-month age group, a PPV of 93% and NPV of 82% were found when applying both parameters.

Conclusions:

The results are consistent with the literature: LE is sensitive for UTI diagnosis and nitrite is specific. The best indicator for UTI exclusion was LE. These results can be applied in the child and adolescent health visits in primary care.

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