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Diagnosis of urinary tract infections in children
1Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA. Raymond.Quigley@UTSouthwestern.edu
Insights
Prompt diagnosis of pediatric urinary tract infections (UTIs) is crucial to prevent kidney damage. New rapid tests can help identify children needing urine cultures, improving efficiency in diagnosing UTIs.
Area of Science:
- Pediatric infectious diseases
- Clinical diagnostics
- Nephrology
Background:
- Urinary tract infections (UTIs) are a major cause of serious bacterial infections in children.
- Untreated UTIs can lead to chronic kidney disease, highlighting the need for prompt diagnosis and treatment.
Purpose of the Study:
- To review advances in diagnosing UTIs in children.
- To evaluate the efficacy of new diagnostic technologies for pediatric UTIs.
- To understand the role of UTI prevalence in guiding clinical work-up.
Main Methods:
- Review of recent meta-analyses on urine test performance in children.
- Analysis of rapid diagnostic techniques including dipstick tests, microscopic analysis, and automated analyzers.
- Examination of studies on UTI prevalence in various pediatric populations.
Main Results:
- Technological advancements enable faster urine examinations.
- Rapid tests show potential in identifying children with and without UTIs.
- Understanding UTI prevalence helps target diagnostic efforts toward high-risk groups.
Conclusions:
- Urine culture remains the gold standard but has limitations (collection, time).
- Rapid techniques like dipstick analysis and automated cell counting offer faster results.
- Selective urine culturing based on low-probability elimination and risk stratification is feasible.
Purpose Of Review:
Urinary tract infections remain a significant cause of serious bacterial infections in children and can result in chronic kidney disease. Thus, prompt diagnosis and initiation of treatment of urinary tract infections are paramount objectives.
Recent Findings:
A number of advances in technology have allowed expeditious examination of the urine. Recent meta-analyses evaluated the ability of these tests to determine the presence or absence of urinary tract infection in children. In addition, understanding the prevalence of urinary tract infection in various populations will help guide the clinician to the appropriate level of suspicion and the appropriate work-up for urinary tract infection.
Summary:
Although culture of the urine remains the gold standard for diagnosing and treating urinary tract infections, technical considerations including method of collection of the urine as well as the time necessary for culture results remain problematic. More rapid techniques include dipstick analyses for the presence of leukocyte esterase or nitrites, microscopic analysis for white blood cells or bacteria, and automated urine cell analyzer to determine bacterial and white blood cell counts in the urine. Recent results indicate it is possible to limit the number of urine cultures performed by eliminating those that have a low probability of being positive. In addition, recent studies reexamining the prevalence of urinary tract infections in various populations indicate that diagnostic testing can be aimed at those patients who are in the higher-risk groups.
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