title: Development of a score based on urinalysis to improve the management of urinary tract infection in children.
abstract: 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 automated microscopy IRIS iQ200 combined with the dipstick analyses 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 474 consecutive urine samples retrospectively analyzed, 69 were positive at urine culture with prevalence of infection of 14.6%. Parameters significantly associated with the presence of infection in multivariable analysis were age <1 year (p<0.001), leukocyte esterase ≥ 15×10^6/L (p<0.001), number of small particles (ASP) ≥ 5500 × 10^6/L (p<0.001) and bacteria ≥ 3 × 10^6/L (p=0.01). The derived score ranged from 0 to 10, with higher values indicating higher risk of UTI. The area under the score ROC curve was 79% (95% CI 0.72-0.85), and was better than those of the individual urinary chemical and microscopic analyses.
  
  
  CONCLUSIONS
  This routine method could improve the management of UTI in children by early identifying patients with low probability of infection, for whom antibiotic treatment can be withheld until the results of urine culture become available.
authors: Department of Laboratory Medicine, Bambino Gesù Children's Hospital, Rome, Italy.
authors: Rosa
authors: R
authors: Luciano
authors: Simone
authors: S
authors: Piga
authors: Leonardo
authors: L
authors: Federico
authors: Marta
authors: M
authors: Argentieri
authors: Francesca
authors: F
authors: Fina
authors: Marina
authors: M
authors: Cuttini
authors: Emilia
authors: E
authors: Misirocchi
authors: Francesco
authors: F
authors: Emma
authors: Maurizio
authors: M
authors: Muraca
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016002:Discriminant Analysis; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016482:Urinalysis / Q000379:methods*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000652:urine*