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Rule Out UTI. Shaikh N et al. Prevalence of urinary tract infections in childhood. A meta- analysis. Ped Infect Dis J 2008. Prevalence of Disease - Girls. 3 – 6 mos: 5% or 1/20 6 – 12 mos: 8% or 1/12 12 – 24 mos: 2% or 1/50. Prevalence - Males. Uncirc: 3 – 12 mos: 5-7% or 1/16- 1/20
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Shaikh N et al. Prevalence of urinary tract infections in childhood. A meta- analysis. Ped Infect Dis J 2008
Prevalence of Disease - Girls 3 – 6 mos: 5% or 1/20 6 – 12 mos: 8% or 1/12 12 – 24 mos: 2% or 1/50
Prevalence - Males Uncirc: 3 – 12 mos: 5-7% or 1/16- 1/20 Circ: 3 – 12 mos: 2% or 1/50
Marc Gorelick, Kathy Shaw, A. Hoberman Clinical decision rule to identify febrile young girls at risk for urinary tract infection. Arch Pediatr Adolesc Med 2000. Validation of a decision rule identifying febrile young girls at high risk for urinary tract infection. Ped Emerg Care 2003.
Decision Guideline Excludes: Kids with obvious bacterial cause of fever – meningitis, pneumonia, strep pharyngitis Kids with definitive viral dx – Varicella, Coxsackie, Herpetic stomatitis Kids with HSP, Kawasaki’s
Girls < 2 years • 2 or more of: • T > 39oC • white • age < 12 months • no other source of fever • fever > 2 days • past history of UTI • symptoms specific to UTI
13 m Hisp female with 103 fever Fever for one day URI on exam No hx of UTI or UTI sx = No need to do U/A
9 m Cauc female with 101.5 • Fever for 3 days • No URI or AGE • No hx of UTI or UTI sx • = Get a urine
Boys < 1 year • uncircumcised, or • age < 6 months and no other source of fever • past history of UTI • symptoms specific to UTI
Diagnostic Testing Urine dipstick for LE, Nitrite
What is a positive? 1+ LE or greater + Nitrite whether or not LE is positive
Dip - Diagnostic Accuracy: Sensitivity ~ 85% Specificity ~ 90%
After dip, what is chance of disease? Dip negative – if chance of UTI was ~ 1/20, now ~ 1/120 Dip positive – if chance of UTI was ~ 1/20, now between 1/2 to 1/3 chance
Cystitis and Urine CulturingCystitis must be clearly defined
Considering Eliminating Culture Dysuria, frequency. Age > 3 years No evidence of upper tract disease – fever, back pain, vomiting, abd pain. No UTI in the last year LE and Nitrite Positive No chance of Herpes Labialis or STD