Abstract
Background: Urinary tract infections (UTI) are among the most common infections in children. The primary tool to detect UTI is dipstick urinalysis; however, this has limited sensitivity and specificity. Therefore, urine culture has to be performed to confirm a UTI. Urinary volatile organic compounds (VOC) may serve as potential biomarker for diagnosing UTI. Previous studies on urinary VOCs focused on detection of UTI in a general population; therefore, this proof-of-principle study was set up in a clinical high-risk pediatric population. Methods: This study was performed at a tertiary nephro-urological clinic. Patients included were 0–18 years, clinically suspected of a UTI, and had abnormal urinalysis. Urine samples were divided into four groups, i.e., urine without bacterial growth, contamination, colonization, and UTI. VOC analysis was performed using an electronic nose (eNose) (Cyranose 320®) and VOC profiles of subgroups were compared. Results: Urinary VOC analysis discriminated between UTI and non-UTI samples (AUC 0.70; p = 0.048; sensitivity 0.67, specificity 0.70). The diagnostic accuracy of VOCs improved when comparing urine without bacterial growth versus with UTI (AUC 0.80; p = 0.009, sensitivity 0.79, specificity 0.75). Conclusions: In an intention-to-diagnose high-risk pediatric population, UTI could be discriminated from non-UTI by VOC profiling, using an eNose. Since eNose can be used as bed-side test, these results suggest that urinary VOC analysis may serve as an adjuvant in the diagnostic work-up of UTI in children.
Highlights
Urinary tract infections (UTI) are among the most common bacterial infections in children worldwide [1]
The previous studies on urinary volatile organic compounds (VOC) focused on detection of UTI in a general population, using mostly anonymous urine samples, while the potential of VOCs as biomarker of UTI
In this proof-of-principle study, we tested the performance of urinary VOC profiles for the diagnosis of UTI in children with a history of renal or urological diseases suspected of UTI and with an abnormal urinary dipstick
Summary
Urinary tract infections (UTI) are among the most common bacterial infections in children worldwide [1]. Urinalysis quantitatively measures urinary leukocytes (white blood cells as a marker of an inflammatory response to infection), nitrite, erythrocytes, and an estimation of bacterial content by microscopy [4] The latter increases the diagnostic accuracy of urine testing [5]. The previous studies on urinary VOCs focused on detection of UTI in a general population, using mostly anonymous urine samples, while the potential of VOCs as biomarker of UTI in a high-risk pediatric population has not been explored yet. This clinical proof-of-principle study was set up to assess whether urinary VOC analysis is a potential tool for the diagnosis of UTI in children, at a tertiary nephro-urological clinic
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