Accuracy of Urinalysis for Urinary Tract Infection in 6 Months to 18 Years Old Children along with Its Bacteriological Profile: Koja General Hospital 2016-2017

Dicky Adi Putra^1, , Ivan Riyanto Widjaja², Anugrah Sitta Latumahina³, Marsha Zaneta¹, Angelina Armine Susanto Putri⁴ and Sudung O. Pardede⁵

¹General Practitioner, Koja General Hospital, Jakarta, Indonesia

²Pediatric Department, Koja General Hospital, Jakarta, Indonesia

³Clinical Pathology Department, Koja General Hospital, Jakarta, Indonesia

⁴Pediatric Department, Tanjung Priok General Hospital, Jakarta, Indonesia

⁵Pediatric Department, Cipto Mangunkusuomo National Central General Hospital, Jakarta, Indonesia

Cite this paper:
Dicky Adi Putra, Ivan Riyanto Widjaja, Anugrah Sitta Latumahina, Marsha Zaneta, Angelina Armine Susanto Putri and Sudung O. Pardede. Accuracy of Urinalysis for Urinary Tract Infection in 6 Months to 18 Years Old Children along with Its Bacteriological Profile: Koja General Hospital 2016-2017. American Journal of Clinical Medicine Research. 2022; 10(1):6-9. doi: 10.12691/ajcmr-10-1-2

Abstract

Background: Accurate diagnosis of urinary tract infection (UTI) in children is crucial, nevertheless it is an intricate process. Combination parameters such as leukocyte esterase (LE) and leukocyte count in urinalysis as initial laboratory exam for a suspected UTI reported to have a high sensitivity and specificity. Urine culture as the gold standard may take some time, while prompt treatment is imperative. Methods: From July 2016 to June 2018 paired urinalysis and urine culture data from in-patient in Koja General Hospital age 6 months to 18 years old were retrieved. Diagnostic study was done for each individual component i.e. LE, nitrite, bacteria, and leukocytes. Urinary pathogen and antibiotic susceptibility patterns were descriptively analyzed. Results: One-hundred-seventeen data were eligible for analysis. Median age of subjects was 2 years old (6 month-18 years), of which 51.3% were boy. Nitrite had the best specificity (98.8%) and accuracy (77.4%) while bacteriuria had the best sensitivity (34.5%). Pyuria and LE had the lowest sensitivity (31% and 17.2% respectively). Bacteria isolated from the culture were all gram negative. Escherichia coli was the most prevalent bacteria, represented 44.8% of the positive cases. Amikacin had the best sensitivity among the antibiotics tested. Conclusion: While in theory pyuria and LE might be used in diagnosing UTI, several factors may distort its value. This should be taken into consideration when a child is suspected of having a UTI.

Keywords:
pediatric urinary tract infection bacteriological profile accuracy of urinalysis

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References:

[1]	Finnell SME, Carroll AE, Downs SM, Subcommittee on Urinary Tract Infection. Technical report — Diagnosis and management of an initial UTI in febrile infants and young children. Pediatrics [Internet] 2011; 128(3): e749-70.
[2]	Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: A meta-analysis. Pediatr Infect Dis J 2008; 27(4): 302-8.
[3]	Miesien M, Tambunan T, Munasir Z. Profil klinis Infeksi Saluran Kemih pada Anak di RS Dr. Cipto Mangunkusumo. Sari Pediatri 2017; 7(4): 200.
[4]	Robinson JL, Finlay JC, Lang ME, et al. Urinary tract infection in infants and children: Diagnosis and management. Paediatr Child Health 2014; 19(6): 315-9.
[5]	Badhan R, Singh DV, Badhan LR, Kaur A. Evaluation of bacteriological profile and antibiotic sensitivity patterns in children with urinary tract infection: A prospective study from a tertiary care center. Indian J Urol 2018; 32(1): 50-6.
[6]	Schroeder AR, Chang PW, Shen MW, Biondi EA, Greenhow TL. Diagnostic Accuracy of the Urinalysis for Urinary Tract Infection in Infants, 3 Months of Age. Pediatrics 2018; 135(6).
[7]	Pardede SO, Tambunan T, Alatas H, Trihono PP HE. Konsensus infeksi saluran kemih pada anak. Jakarta: Badan Penerbit IDAI; 2011.
[8]	Tzimenatos L, Mahajan P, Dayan PS, et al. Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger. Pediatrics [Internet] 2018; 141(2). Available from: http://www.ncbi.nlm.nih.gov/pubmed/29339564.
[9]	Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Managements, KB. R. 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 [Internet] 2011; 128(3): 595-610.
[10]	Roberts KB. The Diagnosis of UTI : Liquid Gold and the Problem of Gold Standards. Pediatrics 2015; 135(6): 5-8.
[11]	Shaikh N, Shope TR, Hoberman A, Vigliotti A, Kurs-Lasky M, Martin JM. Association between Uropathogen and Pyuria. Pediatrics. 2016; 138(1).
[12]	Chaudhari PP, Monuteaux MC, Bachur RG. Urine Concentration and Pyuria for Identifying UTI in Infants. 2016; 138(5).
[13]	Gupta P, Mandal J, Krishnamurthy S, Barathi D, Pandit N. Profile of urinary tract infections in paediatric patients.Indian J Med Res 2015; (April): 473-7.
[14]	Motamedifar M, Zamani K, Hassanzadeh Y, Pashoutan S. Bacterial Etiologies and Antibiotic Susceptibility Pattern of Urinary Tract Infections at the Pediatric Ward of Dastgheib Hospital, Shiraz, Iran: A Three-Year Study (2009-2011) Arch Clin Infect Dis. 2016; 11(2): 2-6.
[15]	Singh SD, Madhup SK. Clinical profile and antibiotics sensitivity in childhood urinary tract infection at Dhulikhel Hospital. Kathmandu Univ Med J [Internet] 2013; 11(44): 319-24.
[16]	Haris S. Kejadian Infeksi Saluran Kemih di Ruang Rawat Inap Anak RSUD Dr. Zainoel Abidin Banda Aceh. Sari Pediatri. 2012; 14(4): 235-40.
[17]	Subandiyah K. Bacterial etiologic agents of urinary tract infections in children at Saiful Anwar Hospital, Malang. J Kedokt Brawijaya 2004; XX(2): 57-61.
[18]	Moore CE, Sona S, Poda S, et al. Antimicrobial susceptibility of uropathogens isolated from Cambodian children. 2016; 113-7.
[19]	Stultz JS, Doern CD, Godbout E. Antibiotic Resistance in Pediatric Urinary Tract Infections. Curr Infect Dis Rep [Internet] 2016; 1-9.
[20]	Gökçe İ, Çiçek N, Güven S, et al. Changes in bacterial resistance patterns of pediatric urinary tract infections and rationale for empirical antibiotic therapy. Balkan Med J 2017; 34(5): 432-5.
[21]	Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. BMJ 2016; 352: i939.