Pediatric emergency medicine trisk 2292 2292
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TABLE 94.16
PERFORMANCE CHARACTERISTICS OF URINALYSIS VARIABLES
Test
Sensitivity (range),
%
Specificity (range),
%
Leukocyte esterase
Nitrite
Either leukocyte esterase or nitrite positive
Microscopy (WBC/HPF)
83 (67–94)
53 (15–82)
93 (90–100)
73 (32–100)
78 (64–92)
98 (90–100)
72 (58–91)
81 (45–98)
Microscopy (bacteria)
Leukocyte esterase, nitrite, or microscopy positive
81 (16–99)
99.8 (99–100)
83 (11–100)
70 (60–92)
WBC, white blood count; HPF, high-power field.
Reproduced with permission from The Subcommittee on Urinary Tract Infection. Urinary tract infection: clinical practice guideline for the diagnosis and
management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595. Copyright © 2011 by American Academy of
Pediatrics
TABLE 94.17
CRITERIA FOR THE DIAGNOSIS OF A URINARY TRACT INFECTION BY CULTURE
Source
Colony count (pure culture)
Probability of infection
Suprapubic aspiration
Gram-negative rods: any
Gram-positive cocci ≥1,000
99%
99%
Transurethral catheterization
≥100,000
10,000–100,000
1,000–10,000
≤1,000
≥10,000
95%
Infection likely
Suspicious: repeat
Infection unlikely
Infection likely
Clean void: boy
Clean void: girl
≥10,000
Three specimens ≥100,000
Two specimens ≥100,000
One specimen ≥100,000
Infection likely
95%
90%
80%
50,000–100,000
10,000–50,000
10,000–50,000
<10,000
Suspicious; repeat
Symptomatic: suspicious; repeat
Asymptomatic: infection unlikely
Infection unlikely
Adapted from The Subcommittee on Urinary Tract Infection. Urinary tract infection: clinical practice guideline for the diagnosis and management of the
initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595.
Management: Most patients are candidates for oral therapy. Indications for parenteral antibiotics include
toxicity; young age (<2 months); refusal to drink or vomiting; immunocompromise; anatomic factors that may
cause an obstruction to urinary flow; or culture-positivity for a pathogen known to be resistant to oral antibiotics
(e.g., extended spectrum beta-lactamase [ESBL]-producing Klebsiella or E. coli isolates). It is critical that
providers are cognizant of antibiotic resistance patterns in their area. If urine culture results are already available,
the most narrow spectrum antibiotic providing coverage should be selected. If the child is in an area where many
E. coli isolates are resistant to ampicillin and/or TMP-SMZ, empiric therapy with a latter generation cephalosporin
is reasonable. For children requiring parenteral antibiotics, a third-generation cephalosporin often is used
empirically, with coverage narrowed as susceptibilities become available. It is recommended that a 7- to 14-day
course of antibiotics be prescribed, as these have been shown to be superior to shorter (1 to 3 day) courses for
children. Standard precautions are indicated for children with UTIs.
