value of a positive nitrate test in routine urine analysis for the diagnosis of childhood UTI

ABSTRACT

Urinary tract infection [UTI] is one of the most common diseases in children. Its diagnosis depends mainly on urine culture. Urinalysis is used as a screening test to exclude UTI. A hospital based, prospective case-review study was carried out at the Pediatric Department, Al-Adan Hospital, State of Kuwait. The objectives of this study is l.To determine the proportion of positive urine cultures identified in patient less than 12 years of age, admitted to hospital and was found to have a positive nitrite test in the routine urinanalysis. 2.Furthermore, to study the confound factors which increase the sensitivity of this test in order to reduce unnecessary culture of urinanalysis. A total of eighty patients admitted to Pediatrics wards at Al-Adan Hospital over a period of four months were found to have a positive nitrite test in routine urinanalysis. only 38 [47%] were significantly positive [pure bacterial growth of >= 100000 CFU/ml].Other studied confound factors such as fever, urinary symptoms, rigors, family history and past history of UTI, history of nocturnal enuresis or constipation were only significant if taken in combination [of those with positive urine cultures 97% had more than one factor]. Urinary leukocyte count was significantly elevated [> 10/hpf] in 90% of the patients with a positive urine cultures. Our data indicates that ordering urine culture in patients with a positive nitrite in urinanalysis should be restricted only to those who also have elevated urinary leukocyte esterase and those who have one or more risk factor for UTI