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

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