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Utility of a routine urinalysis in children who require clean intermittent catheterization
C S Forster1, D B Haslam1, E Jackson2
1Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Routine urinalysis has limited sensitivity but good negative predictive value for predicting urinary tract infections (UTIs) in children requiring clean intermittent catheterization (CIC). A composite urinalysis offers the best predictive accuracy for UTI in this population.
Area of Science:
- Pediatric Nephrology
- Urology
- Infectious Diseases
Background:
- Children requiring clean intermittent catheterization (CIC) often present with positive urine cultures, complicating urinary tract infection (UTI) diagnosis due to a lack of standardized criteria.
- While routine urinalysis (UA) is generally accurate for UTI detection in children, its utility in the CIC population is understudied.
Purpose of the Study:
- To assess the effectiveness of various urinalysis (UA) parameters in predicting UTIs among children who use CIC.
- To identify a combination of UA findings that maximizes diagnostic accuracy for UTIs in this specific pediatric group.
Main Methods:
- A cross-sectional study involving 133 children on CIC, analyzing UA and urine culture results.
- Patients were categorized into UTI and no-UTI groups based on culture results and presence of specific symptoms.
- Statistical analysis included Chi-squared tests, t-tests, and logistic regression to evaluate individual and composite UA parameters for UTI prediction.
Main Results:
- Positive nitrites demonstrated the highest specificity (84.4%) for UTI detection.
- No single UA parameter showed high positive predictive value, but all exhibited high negative predictive values.
- A composite model combining >10 white blood cells and moderate/large leukocyte esterase yielded the best predictive accuracy (PPV 33.3%, NPV 90.4%).
Conclusions:
- Routine urinalysis offers limited sensitivity but moderate specificity for identifying UTIs in children using CIC.
- The developed composite UA and findings of moderate to large leukocyte esterase demonstrate good negative predictive value for ruling out UTIs in this patient cohort.
Background:
Children who require clean intermittent catheterization (CIC) frequently have positive urine cultures. However, diagnosing a urinary tract infection (UTI) can be difficult, as there are no standardized criteria. Routine urinalysis (UA) has good predictive accuracy for UTI in the general pediatric population, but data are limited on the utility of routine UA in the population of children who require CIC.
Objective:
To determine the utility of UA parameters (e.g. leukocyte esterase, nitrites, and pyuria) to predict UTI in children who require CIC, and identify a composite UA that has maximal predictive accuracy for UTI.
Methods:
A cross-sectional study of 133 children who required CIC, and had a UA and urine culture sent as part of standard of care. Patients in the no-UTI group all had UA and urine cultures sent as part of routine urodynamics, and were asymptomatic. Patients included in the UTI group had growth of ≥50,000 colony-forming units/ml of a known uropathogen on urine culture, in addition to two or more of the following symptoms: fever, abdominal pain, back pain, foul-smelling urine, new or worse incontinence, and pain with catheterization. Categorical data were compared using Chi-squared test, and continuous data were compared with Student's t-test. Sensitivity, specificity, and positive and negative predictive values were calculated for individual UA parameters, as well as the composite UA. Logistic regression was performed on potential composite UA models to identify the model that best fit the data.
Results:
There was a higher proportion of patients in the no-UTI group with negative leukocyte esterase compared with the UTI group. There was a higher proportion of patients with UTI who had large leukocyte esterase and positive nitrites compared with the no-UTI group (Summary Figure). There was no between-group difference in urinary white blood cells. Positive nitrites were the most specific (84.4%) for UTI. None of the parameters had a high positive predictive value, while all had high negative predictive values. The composite model with the best Akaike information criterion was >10 urinary white blood cells and either moderate or large leukocyte esterase, which had a positive predictive value of 33.3 and a negative predictive value of 90.4.
Conclusion:
Routine UA had limited sensitivity, but moderate specificity, in predicting UTI in children who required CIC. The composite UA and moderate or large leukocyte esterase both had good negative predictive values for the outcome of UTI.
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