Urinalysis not accurate for diagnosing UTIs in children with spina bifida
Click Here to Manage Email Alerts
Key takeaways:
- UTIs are common among children with spina bifida.
- Individual urinalysis findings had a poor diagnostic accuracy for symptomatic UTI.
Urinalysis did not accurately diagnose UTIs in children with spina bifida, according to study results published in Pediatrics.
“UTIs are common in children with spina bifida,” the authors wrote. “Approximately half of all children with spina bifida will experience a UTI by 15 months of age, and 44% will have more than five UTIs by 15 years.”
The frequency of asymptomatic bacteriuria and the lack of data on the diagnostic accuracy of routine urinalysis (UA) for UTIs are two major contributors to the lack of clarity around accurately diagnosing a UTI in children with spina bifida, they wrote.
One of the authors told Healio that the inspiration for the investigation came during their medical training.
“During my clinical training, I saw kids with spina bifida who required inpatient admission for [peripherally inserted central catheter] line placement for IV antibiotics for UTIs with antibiotic-resistant organisms,” Catherine S. Forster, MD, MS, FAAP, a pediatric hospitalist and researcher at the University of Pittsburgh School of Medicine, told Healio.
“I thought that one driver of antibiotic resistance could be overuse of antibiotics, and thus, wanted to understand whether we are diagnosing UTIs appropriately in this population,” Forster said.
Forster and colleagues conducted a retrospective cohort study at two large children’s hospitals of all paired UA and urine cultures from patients with myelomeningocele from Jan. 1, 2016, to Dec. 31, 2021. The primary outcome was a symptomatic UTI.
The researchers also controlled for multiple encounters per child and calculated area under the receiver operating characteristics curve, sensitivity and specificity for positive nitrites; pyuria, at a cutoff of 10 or more white blood cells per high-powered field; and leukocyte esterase, or more than a trace amount, for a symptomatic UTI.
In all, the study included 974 encounters with 319 unique children, among whom 12.3% met the criteria for a UTI.
Regarding the diagnostic accuracy of each UA component, pyuria had the highest sensitivity (0.91, 95% CI, 0.84-0.95) and the least specificity (0.36, 95% CI, 0.33-0.4), whereas nitrites were the least sensitive (0.52, 95% CI, 0.42-0.61) and most specific (0.72, 95% CI, 0.69-0.75).
Among all encounters, the overall area under the receiver operating characteristics curve for all components of the UA was lower in children who used clean intermittent catheterizations compared with all others.
Ultimately the researchers found that individual UA findings had moderate sensitivity to leukocyte esterase and pyuria and moderate specificity to nitrites but overall had a poor diagnostic accuracy for symptomatic UTIs in children with spina bifida.
“We all suspected that UA is a pretty poor way of diagnosing a UTI in kids with spina bifida but lacked data from a large number of patients, such as we present here, to support this claim,” Forster said.
Forster added that she hopes primary care providers and pediatricians now know “not to rely solely on UA to diagnose a UTI in a child with spina bifida.”
Collapse
Read more about
Click Here to Manage Email Alerts