Urinary tract infection in children: clinical aspects and utility of urine dipstick test

Abstract

Background: Urinary tract infection (UTI) is a common genitourinary disease in children and accounts for significant morbidity. To prevent the potentially dangerous sequel, early detection of UTI in childhood is essential. This depends entirely on strong clinical suspicion and urine culture report. Recently, advances in investigations are taking place to diagnose UTI rapidly. Urine dipstick is one such bedside method to diagnose UTI. This study aims at studying the clinical features of UTI and evaluating sensitivity and specificity of urine dipstick in diagnosing UTI.Methods: This study was conducted at a tertiary care hospital in Vadodara from January 2013 to June 2014, on 60 children admitted with clinical suspicion of urinary tract infection. Along with study of clinical features, results of urine dipstick tests (Nitrite and Leukocyte esterase), urine microscopy and urine culture were compared. Accuracy of urine dipstick tests was assessed statistically by evaluating sensitivity, specificity, positive and negative predictive values considering urine culture as a gold standard.Results: Fever was found to be the most common presenting features (53%) in all the patients studied. The sensitivity of urine microscopy, Nitrite test and Leucocyte esterase test was 63.5%, 50% and 61% and specificity was 25%, 31% and 25% respectively. Combination of Nitrite and Leucocyte Esterase test had an improved sensitivity (68%).Conclusions: Urinary tract infection can present with variety of non-specific signs and symptoms especially in younger age. Dipstick test using Leucocyte Esterase and Nitrite together is better than urine microscopic examination alone. Urine culture as a confirmatory test still remains gold standard.