BACKGROUND The objective of this study was to compare the accuracy of available tests for pyuria, including newer automated tests, and to examine the implications of requiring them for the diagnosis of urinary tract infections (UTIs). METHODS We included children between 1 and 36 months of age undergoing bladder catheterization for suspected UTIs who presented to 1 of 3 pediatric centers. Using a positive urine culture result as the reference standard, we compared the sensitivity of 5 modalities for assessing pyuria at the cutoffs most often used clinically for detecting children with a positive culture result: leukocyte esterase on a dipstick, white blood cell (WBC) count on manual microscopy with and without using a hemocytometer, automated WBC enumeration using flow cytometry, and automated WBC enumeration using digital imaging with particle recognition. RESULTS A total of 4188 children were included. Among febrile children, the sensitivity of the 2 most widely available modalities, the leukocyte esterase test and WBC enumeration using digital imaging, had sensitivity values of 84% (95% confidence interval, 0.80-0.87) and 75% (95% confidence interval, 0.66-0.83), respectively. CONCLUSIONS Our findings suggest that for febrile children <36 months of age undergoing bladder catheterization for suspected UTI, pyuria will be absent in ∼20% of children who are eventually shown to have pure growth of a pathogen on a culture. This raises questions about the appropriateness of requiring pyuria for the diagnosis of UTIs.

中文翻译：

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筛查测试诊断幼儿尿路感染的准确性。


背景 本研究的目的是比较可用的脓尿测试的准确性，包括更新的自动化测试，并检查要求它们用于诊断尿路感染 （UTI） 的影响。方法 我们纳入了 1 至 36 个月大因疑似 UTI 接受膀胱导管插入术的儿童，这些儿童在 3 个儿科中心中的 1 个就诊。以阳性尿培养结果作为参考标准，我们比较了临床上最常用于检测培养结果阳性儿童的 5 种评估脓尿的方法的敏感性：试纸上的白细胞酯酶，使用和不使用血细胞计数器的手动显微镜检查白细胞 （WBC） 计数，使用流式细胞术自动进行 WBC 计数， 以及使用具有颗粒识别功能的数字成像进行自动 WBC 计数。结果 共纳入 4188 例儿童。在发热儿童中，两种最广泛可用的方式，即白细胞酯酶试验和使用数字成像的 WBC 计数，其敏感性值分别为 84% （95% 置信区间，0.80-0.87） 和 75% （95% 置信区间，0.66-0.83）。结论 我们的研究结果表明，对于因疑似 UTI 而接受膀胱导管插入术的发热儿童 <36 个月大，约 20% 的儿童将不存在脓尿，这些儿童最终在培养物中显示病原体的纯生长。这引发了关于需要脓尿诊断 UTI 的适当性的问题。