Main Article Content
urinary tract infection (UTI) need special attention considering
kidney complications, unspecified symptoms, and difficult urine
sample collection. Urinalysis was the main supportive examination
for UTI because of its immediate result and widespread
Objective To estimate urine nitrite, leukocyte esterase (LE),
leucocyturia, bacteriuria, and their combinations as a diagnostic
tool for febrile UTI in children aged 2 months to 2 years.
Methods This is a diagnostic study held in Cipto Mangunkusumo
Hospital, Tangerang General Hospital, Fatmawati Hospital, and
Budhi Asih Hospital, involving 7 5 children aged 2 months to 2
years. Urine samples for urinalysis and urine culture were collected
using urine collector in all subjects. Clinical pathologists who
performed urine culture, did not know the results of urinalysis.
Results By parallel test analyses, we found that the best diagnostic
value was the combination of 3 tests (LE, leucocyturia, and
bacteriuria). This combination test showed sensitivity, specificity,
positive predictive value (PPV), negative predictive value (NPV),
positive likelihood ratio (LR+), and negative likelihood ratio
(LR-) of 69%, 95%, 85%, 88%, 13.1, and 0.3.
Conclusion The combination test of LE, leucocyturia, and
bacteriuria shows high specificity, NPV, and LR+ . Therefore, the
negative results of these 3 tests in combination can be used to rule
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
2. Miesien, Tambunan T, Munasir Z. Profil klinis infeksi saluran kemih pada anak di RS Dr. Cipto Mangunkusumo. Sari Pediatri. 2006;7:200-6.
3. Marone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008;27:302-8.
4. Shaw KN, Gorelick M, McGowan KL, Yakscoe NM, Schwartz JS. Prevalence of urinary tract infection in febrile young children in the emergency department. Pediatrics. 1998;102-8.
5. Haberman A, Chao HP, Keller DM. Prevalence of urinary tract infection in febrile infants. J Pediatr. 1993;123:17-23.
6. Shaikh N, Ewing AL, Bhatnagar S, Haberman A. Risk of renal scarring in children with a first urinary tract infection : a systematic review. Pediatrics. 2010;126:1084-91.
7. Benador D, Benador N, Slosman D, Mennillod B, Girardin E. Are younger children at highest risk of renal sequelae after pyelonephritis? Lancet. 1997;349:17-9.
8. Finnell SME, Carroll AE, Downs SM. The Subcommittee on Urinary Tract Infection. Technical reports - diagnosis and management of an initial UTI in febrile infants and young children. Pediatrics. 2011;128:749-70.
9. Ramlakhan SL, Burke DP, Goldman RS. Dipstick urinalysis for the emergency department evaluation of urinary tract infections in infants aged less than 2 years. Eur J Emerg Med 2011;18:221-4.
10. Bachur R, Harper MB. Reliability of the urinalysis for predicting urinary tract infections in young febrile children. Arch Pediatr Adolesc Med 2001;155:60-5.
11. Mori R, Yonemoto N, Fitzgerald A, Tullus K, Verrier-Jones K, Lakhanpaul M. Diagnostic performance of urine dipstick testing in children with suspected UTI: a systematic review of relationship with age and comparison with microscopy. ActaPaediatrica. 2010;99:581-4.
12. Daley A, Nelligan M. Is a negative dipstick urinalysis good enough to exclude urinary tract infection in paediatric emergency department patients? Emerg Med. 2003;15:77-80.
13. Shaw KN, McGowan KL, Gorelick MH, Schwartz JS. Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatrics. 1998;101:1-5.
14. Haberman A, Wald ER, Reynolds EA, Penchansky L, Charron M. Is urine culture necessary to rule out urinary tract infection in young febrile children? Pediatr Infect Dis J. 1996;15:304-9.
15. Kanellopoulos TA, Salakos C, Spiliopoulou I, Ellina A, Nikolakopoulou NM. First urinary tract infection in neonates, infants, and young children: a comparative study. Pediatr Nephrol. 2006;21:1131-7.
16. Garner B, Anacleta F. Clinical and laboratorium profile of urinary tract infection among children at the outpatient clinic ofa tertiary hospital. Pids Phil. 2010;11:10-16.
17. Zorc JJ, Kiddoo DA, Shaw KN. Diagnosis and management of pediatric urinary tract infections. Clinical Micro biol Rev. 2005;18:417-22.
18. Lane DR, Takhar SS. Diagnosis and management of urinary tract infection and pyelonephritis. Emergency medicine clinics of North America. 2011:29;539-52.
19. Wald E. Genitourinary tract infections: cys titis and pyelonephritis. In: Feigin R, Cherry JD, Demmler GJ, Kaplan SL, editors. Textbook of Pediatric Infectious Diseases. 5th edition. Philadelphia,PA: Saunders; 2004. p.541-55.
20. Haberman A, Wald ER. Urinary tract infections in young febrile children. Pediatr Infect Dis J. 1997;16:11-7.
21. Shaikh N, Marone NE, Lopez J. Does this child have a urinary tract infection? JAMA. 2007;298:2895-904.
22. Santen SA, Altieri MF. Pediatric urinary tract infection. Emerg Med Clin North Am. 2001;19:675-90.
23. Alper BS, Curry SH. Urinary tract infection in children. Am Fam Phys. 2005;72:2483-8.
24. Downs SM. Technical report: urinary tract infections in febrile infants and young children. Pediatrics. 1999; 103:1-60.
25. Ma JF, Shortliffe LM. Urinary tract infection in children: etiology and epidemiology. Urol Clin North Am. 2004;31:517-26.
26. Naseri M, Alamdaran A. Urinary tract infection and predisposing factors in children. Iran J Ped. 2007; 17:263-70.
27. Ross JH. Urinary tract infections: 2000 update. Am Fam Physician. 2000;62:1773-7.
28. Riccabona M. Urinary tract infections in children. Current Opinion in Urology. 2003;13:59-62.
29. Naseri M, Alamdaran A. Urinary tract infection and predisposing factors in children. Iran J Ped. 2007;17:263-70.
30. Schroeder AR, Newman TB, Wasserman RC, Finch SA, Pantel RH. Choice of urine collection methods for the diagnosis of urinary tract infection in young, febrile infants. Arch Pediatr Adolesc Med. 2005;159:915-22.