Development of a Score Based on Urinalysis to Improve the Management of Urinary Tract Infection in Children

Abstract

Objectives: Our aim is to develop a score that may help in reducing the misuse of antibiotics in treatment of urinary tract infection before appearance of urine culture. Background: The need for reducing unnecessary antibiotic treatment is being emphasized in the management of urinary tract infections (UTI), a disease frequent in childhood. An ideal test should provide early diagnosis without the waiting times of urine culture, but even a simple test of exclusion could significantly improve patient management. Methods: We evaluated the sensitivity, specificity, negative and positive predictive value of urine analysis, dipstick (leukocyte esterase and nitrite) and bacterial colony count in children with suspected UTI. Multivariable logistic regression analysis was used to identify the set of variables that best predict positive culture results and develop a numerical risk score. Results: Of 200 children were having symptoms of UTI, 93 child had confirmed UTI with prevalence 46.5%. Parameters significantly associated with the presence of infection in multivariable analysis were age 9-12 years (p < 0.05), leukocyte esterase positive (p < 0.001), nitrite positive (p < 0.05), pus cell >10/HPF (p < 0.05), RBCs>10/HPF (p < 0.05) and bacteria ≥ 10^6 (p < 0.05).The derived score ranged from 1 to 7, with higher values indicating higher risk of UTI. Conclusion: This routine method could improve the management of UTI in children by early identifying patients with low probability of infection, for which antibiotic treatment can be withheld until the results of urine culture become available.