Role of urine Gram stain in young febrile infants with a suspected urinary tract infection: a cohort study.

Autor:	Gomez B; Pediatric Emergency Department, Hospital Universitario Cruces, Biobizkaia Health Research Institute, Barakaldo, Spain borja.gomezcortes@osakidetza.eus., Mier A; Pediatric Emergency Department, Hospital Universitario Cruces, Barakaldo, Spain., Ugedo A; Pediatric Emergency Department, Hospital Universitario Cruces, Barakaldo, Spain., Aguirre-Quiñonero A; Department of Microbiology, Hospital Universitario Cruces, Barakaldo, Spain., Benito J; Pediatric Emergency Department, Hospital Universitario Cruces, Biobizkaia Health Research Institute, Barakaldo, Spain.; Department of Pediatrics, Universidad del Pais Vasco, Bilbao, Spain., Mintegi S; Pediatric Emergency Department, Hospital Universitario Cruces, Biobizkaia Health Research Institute, Barakaldo, Spain.; Department of Pediatrics, Universidad del Pais Vasco, Bilbao, Spain.
Jazyk:	angličtina
Zdroj:	Archives of disease in childhood [Arch Dis Child] 2024 Sep 25; Vol. 109 (10), pp. 801-805. Date of Electronic Publication: 2024 Sep 25.
DOI:	10.1136/archdischild-2024-327182
Abstrakt:	Objective: To analyse the performance of the urine Gram stain for predicting a positive urine culture (UC) in young infants with fever without source (FWS) and pyuria. Design: Observational study; secondary analysis of a prospective registry-based cohort study. Setting: Paediatric emergency department; tertiary teaching hospital. Patients: Infants ≤90 days old with FWS, pyuria and urine Gram stain requested seen between 2010 and 2022. Main Outcome Measure: Performance of the Gram stain, defined as positive if any bacteria were seen, for predicting urinary tract infection (UTI: UC by urethral catheterisation growing >10 000 CFU/mL of a single bacterial pathogen). Results: Among 367 febrile infants with pyuria, 281 (76.6%) had a positive Gram stain and 306 (83.3%) had a positive UC (277; 90.5% Escherichia coli ).Rates of positive UC in patients with positive and negative Gram stains were 97.2% and 38.4%, respectively (p<0.01), showing a sensitivity of 89.2% (95% CI: 85.2% to 92.2%) and a specificity of 86.9% (95% CI: 76.2% to 93.2%). Sensitivity was lower for diagnosing UTIs caused by bacteria other than E. coli (69.0% vs 91.3% for UTIs caused by E. coli ; p<0.01).Two (2.1%) of the 86 infants with negative Gram stains were diagnosed with bacteraemia unrelated to a UTI ( Streptococcus pneumoniae and Staphylococcus aureus ). Conclusions: Around a third of infants with pyuria and a negative Gram stain will eventually be diagnosed with a UTI. These patients have a higher rate of UTIs caused by bacteria other than E. coli . Bacterial infections other than UTIs should also be considered in such cases. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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