Sandoval Claudio, Sinaki Banafsheh, Weiss Robert, Munoz Jose, Ozkaynak M Fevzi, Tugal Oya, Jayabose Somasundaram
Department of Pediatrics and Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York 10595, USA.
Pediatr Hematol Oncol. 2012 Feb;29(1):68-72. doi: 10.3109/08880018.2011.617809.
The relevancy of the urinary tract as a source of infection during febrile neutropenia is not known. The authors sought to determine the frequency of urinary tract infections (UTIs) in pediatric cancer patients with febrile neutropenia. Urine was collected from a mid-stream void before the administration of antibiotics. Demographic, clinical, and laboratory data were collected. The frequency of UTI and usefulness of urinalysis and localizing signs in predicting UTI in pediatric cancer patients with fever and neutropenia were determined. Forty-five patients had 58 febrile neutropenic episodes eligible for study participation. No patient presented with localizing signs. The urinalysis was negative in 53 episodes and positive in 5 episodes. Four patients had 5 UTIs. The frequency of UTI was 8.6% (5 of 58 febrile neutropenia episodes). Four patients had bacteremia, none of whom had a UTI. The sensitivity, specificity, and negative predictive value of urinalysis was 40%, 94%, and 94%, respectively, and for localizing signs was undefined, 100%, and 91%, respectively. UTI is as common as bacteremia in the current pediatric cancer patients with fever and neutropenia. Urinalysis and urine culture should be obtained routinely as part of the diagnostic evaluation of patients with fever and neutropenia.
在发热性中性粒细胞减少症期间，泌尿道作为感染源的相关性尚不清楚。作者试图确定患有发热性中性粒细胞减少症的儿科癌症患者中尿路感染（UTI）的发生率。在使用抗生素之前，从患者中段尿收集尿液。收集人口统计学、临床和实验室数据。确定了UTI的发生率以及尿液分析和定位体征在预测发热性中性粒细胞减少症的儿科癌症患者UTI中的有用性。45名患者发生了58次符合研究参与条件的发热性中性粒细胞减少症发作。没有患者出现定位体征。53次发作的尿液分析结果为阴性，5次为阳性。4名患者发生了5次UTI。UTI的发生率为8.6%（58次发热性中性粒细胞减少症发作中有5次）。4名患者发生了菌血症，其中没有一人患有UTI。尿液分析的敏感性、特异性和阴性预测值分别为40%、94%和94%，定位体征的敏感性、特异性和阴性预测值分别为未定义、100%和91%。在目前患有发热性中性粒细胞减少症的儿科癌症患者中，UTI与菌血症一样常见。作为发热性中性粒细胞减少症患者诊断评估的一部分，应常规进行尿液分析和尿培养。
