Departments of Emergency Medicine and
Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
Pediatrics. 2018 Feb;141(2). doi: 10.1542/peds.2017-3068. Epub 2018 Jan 16.
Reports of the test accuracy of the urinalysis for diagnosing urinary tract infections (UTIs) in young febrile infants have been variable. We evaluated the test characteristics of the urinalysis for diagnosing UTIs, with and without associated bacteremia, in young febrile infants.
We performed a planned secondary analysis of data from a prospective study of febrile infants ≤60 days old at 26 emergency departments in the Pediatric Emergency Care Applied Research Network. We evaluated the test characteristics of the urinalysis for diagnosing UTIs, with and without associated bacteremia, by using 2 definitions of UTI: growth of ≥50 000 or ≥10 000 colony-forming units (CFUs) per mL of a uropathogen. We defined a positive urinalysis by the presence of any leukocyte esterase, nitrite, or pyuria (>5 white blood cells per high-power field).
Of 4147 infants analyzed, 289 (7.0%) had UTIs with colony counts ≥50 000 CFUs/mL, including 27 (9.3%) with bacteremia. For these UTIs, a positive urinalysis exhibited sensitivities of 0.94 (95% confidence interval [CI]: 0.91-0.97), regardless of bacteremia; 1.00 (95% CI: 0.87-1.00) with bacteremia; and 0.94 (95% CI: 0.90-0.96) without bacteremia. Specificity was 0.91 (95% CI: 0.90-0.91) in all groups. For UTIs with colony counts ≥10 000 CFUs/mL, the sensitivity of the urinalysis was 0.87 (95% CI: 0.83-0.90), and specificity was 0.91 (95% CI: 0.90-0.92).
The urinalysis is highly sensitive and specific for diagnosing UTIs, especially with ≥50 000 CFUs/mL, in febrile infants ≤60 days old, and particularly for UTIs with associated bacteremia.
有关尿分析诊断尿路感染（UTI）的检测准确性的报告结果存在差异。本研究评估了伴有或不伴有菌血症的发热婴儿的尿分析对 UTI 的检测特征。
我们对儿科急诊护理应用研究网络（PECARN）26 个急诊部门的≤60 天龄发热婴儿前瞻性研究的数据进行了二次分析。我们通过两种 UTI 定义评估了尿分析对 UTI 的检测特征，即 Uropathogen 的尿培养计数≥50000 或≥10000 个菌落形成单位（CFU）/mL。我们将白细胞酯酶、亚硝酸盐或脓尿（高倍镜视野下>5 个白细胞）的存在定义为阳性尿分析。
在 4147 例婴儿中，有 289 例（7.0%）患有 UTI，菌落计数≥50000 CFU/mL，其中 27 例（9.3%）有菌血症。对于这些 UTI，阳性尿分析的敏感度为 0.94（95%置信区间[CI]：0.91-0.97），无论是否有菌血症；伴有菌血症时为 1.00（95%CI：0.87-1.00）；无菌血症时为 0.94（95%CI：0.90-0.96）。所有组的特异性均为 0.91（95%CI：0.90-0.91）。对于 UTI 菌落计数≥10000 CFU/mL，尿分析的敏感度为 0.87（95%CI：0.83-0.90），特异性为 0.91（95%CI：0.90-0.92）。
对于≤60 天龄发热婴儿，尿分析对于 UTI 的检测具有高度的敏感性和特异性，尤其是对于 UTI 菌落计数≥50000 CFU/mL 的婴儿，并且对于伴有菌血症的 UTI 尤其如此。
