Conference Coverage

When normal urinalysis is a red flag



A normal urinalysis in a febrile child aged younger than 90 days should trigger a thorough workup for invasive bacterial infection, Antonio Arrieta, MD, declared at the annual meeting of the European Society for Paediatric Infectious Diseases.

ESPID 2019 sign announcing conference Bruce Jancin/MDedge News

Moreover, a normal urinalysis in a febrile young infant already known to have an invasive bacterial infection (IBI) constitutes a bright red flag: It’s an independent predictor of an increased risk of major morbidity and mortality, according to Dr. Arrieta, chief of the division of infectious diseases and president of the medical staff at Children’s Hospital of Orange County in Orange, Calif.

“A normal urinalysis should alert the clinician to the possibility of a more serious IBI,” the pediatrician emphasized.

In contrast, an abnormal urinalysis is strongly suggestive of a urinary tract infection, the least serious of the common types of IBI.

Dr. Arrieta presented a retrospective cohort study of 139 children aged younger than 90 days with a proven IBI in the form of meningitis, bacteremia, or urinary tract infection. Fifty-six of the children were neonates. The most common causative microorganisms were Escherichia coli and group B streptococcus, identified in 70 and 40 patients, respectively.

The impetus for this study, the pediatrician explained, is that while emergency department visits for fever are common in young children, and IBIs are often involved, there is scarce literature on the association between presenting features and IBI outcomes. Dr. Arrieta and coinvestigators zeroed in on three presenting features as potential predictors of outcome: urinalysis results, WBC count, and C-reactive protein (CRP) level.

Twenty-four of the 139 febrile children with IBI had poor outcomes, including 20 cases of meningitis with complications and 4 fatalities. Twenty-two of 70 patients with a normal urinalysis had poor outcomes, compared with 2 of 69 with an abnormal urinalysis marked by pyuria greater than 10 WBCs/mm3. In a multivariate logistic regression analysis – and bearing in mind that all of these children had a proven IBI – a normal urinalysis was independently associated with a 33.3-fold increased risk for poor outcome.

“Though we only explored infants with proven IBI, a urinalysis should be a valuable tool for the clinician not only to identify UTI, but also to predict outcome in febrile infants less than 90 days old,” Dr. Arrieta concluded.

Neither WBC count nor CRP was independently associated with IBI outcome. However, a poor outcome occurred in 43% of children with a normal urinalysis and an elevated CRP, but in only 6.5% of those with an abnormal urinalysis and a normal CRP.

Dr. Arrieta reported having no financial conflicts of interest.

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