Pediatrics

Is pyuria necessary for UTI diagnosis in young children?

November 22, 2024

Pyuria is absent in ~20% of febrile children <3 years of age undergoing bladder catheterization for suspected UTIs who later show pure growth of a pathogen on culture. This finding questions the necessity of requiring pyuria for UTI diagnosis.

Researchers included 4,188 children ages 1 to 36 months undergoing bladder catheterization for suspected UTIs at three pediatric centers. Using a positive urine culture result as the reference standard, they compared the sensitivity of five modalities for assessing pyuria: leukocyte esterase on a dipstick, WBC count on manual microscopy with and without use of a hemocytometer, automated WBC enumeration using flow cytometry, and automated WBC enumeration using digital imaging with particle recognition.

Among febrile children, the sensitivity of the two most widely available modalities were:

• Leukocyte esterase test: 84% (95% confidence interval, 0.80-0.87)
• WBC enumeration using digital imaging: 75% (95% confidence interval, 0.66-0.83)

Source:

Shaikh N, et al. (2024, November 20). Pediatrics. Accuracy of Screening Tests for the Diagnosis of Urinary Tract Infections in Young Children. https://pubmed.ncbi.nlm.nih.gov/39563499/