Is antibiotic treatment indicated in a patient with a positive urine culture but no symptoms?

Abstract Primary Subject area Hospital Paediatrics Background Urinary tract infections (UTIs) in infants less than 60 days of age, often lead to hospitalization and intravenous antibiotic treatment. There are currently no national recommendations for the diagnosis and management of UTIs in this population. Historically, the urine culture alone was thought to be sufficient for diagnosing UTI due to concerns regarding the sensitivity of urinalysis (UA) in young infants. However, there is evidence that in children of all ages, the absence of pyuria in children with UTIs is rare. The role of the UA in influencing the current management of infants aged less than 60 days, with a positive urine culture, remains unclear. Objectives The objective of this study was to describe the characteristics of infants aged less than 60 days old with a positive urine culture. Specifically, we sought to: 1) determine the differences in clinical and biochemical characteristics of infants with a positive UA versus a negative UA; and 2) determine if UA result was associated with length of intravenous antibiotic treatment. Design/Methods We completed a retrospective cohort study of infants aged 0 to 60 days with a positive urine culture, cared for in a Canadian tertiary care children’s hospital between April 2016 and March 2019. Patients with a history of prematurity and those with a concomitant bacteremia or meningitis were excluded. A positive urine culture was defined as greater than 10,000 CFU/ml of a single organism obtained from a catheter specimen. A positive UA was defined by positive nitrites and/or a positive leukocyte esterase screen, and/or pyuria (greater than 5 white blood cells per high power field). Clinical and biochemical characteristics of infant groups with a positive UA, versus negative UA, were compared. Linear regression analysis was used to understand the association between UA result and length of intravenous antibiotic treatment. Results A total of 718 charts were screened. Eighty-nine patients met inclusion criteria, of which 52 (58%) had a positive UA and 37 (42%) had a negative UA. Of the 89 included infants, the average age was 32.5 days (SD 16.7), 31.5% were female, 79.8% had fever at presentation, and the average length of stay was 5.6 days (SD 2.9). Patients with a positive UA were more often febrile at presentation (90.3% vs. 64.9%, p = 0.006), and had a higher CRP (51.0, SD 56.1 vs. 8.1, SD 13.0), p < 0.001), higher white blood cell count (15.2, SD 6.0 vs. 11.0, SD 5.7, p= 0.002), and more often had urine culture growth of E. Coli (96.2% vs. 62.9%, p < 0.001). UA result was not associated with length of intravenous antibiotic treatment (p= 0.15). Conclusion This study demonstrates that infants with a positive urine culture and a positive UA result had more characteristics of infection, including fever, elevated CRP, elevated white blood cell count, and growth of E. Coli uropathogen, compared to infants with a negative UA. Despite this difference, there was no significant difference in length of intravenous antibiotic treatment between UA-positive versus UA-negative groups. This study suggests that infants with clinical and biochemical findings supportive of a UTI more often had a positive UA, along with a positive culture, and that the UA should be used as a screening test for UTI in infants aged less than 60 days.

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Risk factors and clinical relevance of positive urine cultures in cats with subcutaneous ureteral bypass

BMC Veterinary Research ◽

10.1186/s12917-021-02898-7 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Julie Deprey ◽

Arnaud Baldinger ◽

Véronique Livet ◽

Margaux Blondel ◽

Mathieu Taroni ◽

...

Keyword(s):

Risk Factors ◽

Body Condition ◽

Bacterial Culture ◽

Urine Culture ◽

Body Condition Score ◽

Positive Urine Culture ◽

Positive Urine ◽

Condition Score ◽

Device Placement

Abstract Background The objective of the study was to report the incidence and risk factors associated with positive urine bacterial cultures as well as long-term outcome in cats with subcutaneous ureteral bypass (SUB) devices. Results Medical records of cats that underwent SUB device placement were retrospectively reviewed. Signalment of the cat, laterality of the ureteral obstruction, surgery, anesthesia and hospitalization duration, bacterial culture results and follow-up data were retrieved. Thirty-two cats met the inclusion criteria. Four cats (12.5%) had a positive intraoperative culture, with two of them being treated successfully. Ten cats out of 28 (35.7%) were documented with a positive urine culture during follow-up period, with a median time between discharge and identification of the first positive urine culture of 159 days (range 8–703 days). Bacteriuria resolved in 60% of cats (6/10). Escherichia coli was the most common organism, isolated in 4 out of 10 postoperative urine cultures. Overall, subclinical bacteriura was documented for 6 of 32 (18.8%) cats and 5 of 32 (15.6%) cats displayed clinicals signs suggestive of persistent UTI. One cat had subclinical bacteriuria. Three cats died during the follow-up period. There was a significant difference between negative and positive urine bacterial culture groups in median hospitalization duration (5 days versus 6 days, P = 0.022) and in median body condition score (5/9 versus 4/9, P = 0.03). Cats with a longer hospital stay and with a lower body condition score were more likely to have a positive urine culture during follow-up period. Conclusions SUB device placement surgery is associated with complications such as chronic bacteriuria. Bacteriuria in our study resolved with appropriate antibiotic treatment in more than half of cats. Risk factors identified for positive urine culture were a longer hospitalization duration and a decreased body condition score.

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Bladder debris on renal and bladder ultrasound: A significant predictor of positive urine culture

Journal of Pediatric Urology ◽

10.1016/j.jpurol.2017.04.020 ◽

2017 ◽

Vol 13 (4) ◽

pp. 385.e1-385.e5 ◽

Cited By ~ 4

Author(s):

Joseph W. McQuaid ◽

Michael P. Kurtz ◽

Tanya Logvinenko ◽

Caleb P. Nelson

Keyword(s):

Urine Culture ◽

Positive Urine Culture ◽

Positive Urine

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1371. Trends in Antibiotic Resistance Among Uropathogens in the Pediatric Population: A Single Center Experience in the US

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1553 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S695-S695

Author(s):

Leena B Mithal ◽

Sebastian Otero ◽

Shan Sun ◽

Mehreen Arshad

Keyword(s):

Antibiotic Resistance ◽

Urine Culture ◽

Pediatric Population ◽

Tertiary Care ◽

Fourth Generation ◽

Care Hospital ◽

Beta Lactams ◽

Positive Urine Culture ◽

Positive Urine ◽

Tract Infections

Abstract Background Urinary tract infections (UTIs) are common infections in children. Overuse of antibiotics has led to an increasing prevalence of antibiotic resistance among uropathogens in adults; however, data on pediatric trends have not been previously reported. Our objective was to characterize antibiotic resistance trends in uropathogens among children at a tertiary care hospital in a diverse urban US city. Methods Positive urine culture data (>20,000 CFU/ml) from January 1st, 2010 through December 31st, 2019 were obtained from the electronic medical records (inpatient and outpatient). Yearly antibiotic agent-specific resistance rates were calculated based on culture, patient, and organism level data. Results A total of 7,512 patients had ≥1 positive urine culture, with 13,327 positive individual cultures. The average age at sample collection was 6 yrs (IQR 2-11). Overall, 66% of cultures showed resistance to at least 1 antibiotic. Ampicillin resistance (50.1% IQR: 48.2%-52.4%) was the most common and remained stable over the study period. However, resistance against amoxicillin-sulbactam, third and fourth generation cephalosporins, and fluoroquinolones has increased significantly over this period (Figure 1). There was also a corresponding increase in the prevalence of extended spectrum beta-lactamase (ESBL) Enterobacteriaceae (Figure 2). Among infants < 1 year, a similar trend in increasing resistance against beta-lactams was noted (ampicillin-sulbactam 0% to 38%, ceftriaxone 0% to 9% and cefepime 0% to 4%, Figure 3). Figure 1 Figure 2 Figure 3 Conclusion There are rising rates of antibiotic resistance to broad spectrum antibiotics, including beta-lactams and quinolones, in a pediatric population over the last 10 years, with a notable increase in resistance starting in 2015-2016. While we were not able to distinguish patients with community acquired UTI, the increase in resistance among infants < 1 year suggests a community reservoir of multi-drug resistant gram-negative bacteria. Colonization by resistant uropathogens has implications for empiric antibiotic choice, limited oral therapy options, and clinical outcomes which necessitate further study. Disclosures All Authors: No reported disclosures

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The negative predictive value of a negative repeat urinalysis in patients presenting with haematuria: A review of 1138 patients

Journal of Clinical Urology ◽

10.1177/2051415817711633 ◽

2017 ◽

Vol 10 (5) ◽

pp. 471-475

Author(s):

Benjamin Zak Starmer ◽

Amal Singh ◽

Stephen Bromage

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Urothelial Cancer ◽

Urine Culture ◽

Bladder Tumour ◽

High Grade ◽

Microscopic Haematuria ◽

Positive Urine Culture ◽

Positive Urine ◽

The One

Objective: Haematuria may be transient for a number of benign conditions, particularly a urinary-tract infection (UTI). We set out to determine if a negative repeat urinalysis at the time of urological assessment for patients with haematuria could predict negative investigations and whether investigations could be tailored by this test. Methods: This was a retrospective analysis of records for all patients attending a haematuria clinic between 16 September 2013 and 12 September 2014. This included patients with visible and non-visible (microscopic) haematuria. Results: There were 1138 patients, 599 with visible haematuria (VH) and 460 with non-visible haematuria (NVH). Seventy-two patients were excluded. A total of 546 patients had a positive repeat urinalysis for blood; 438 patients had a negative repeat urinalysis when tested at the haematuria clinic, 298/599 for VH and 140/460 NVH. For those who had negative repeat urinalysis, urothelial cancer was found in 15/298 VH and 1/140 NVH. The one patient with negative repeat urinalysis and NVH was found to have a grade 2 (high grade) bladder tumour. The negative predictive value for a negative repeat urinalysis in transient haematuria was 0.95 for VH and 0.99 for NVH. Twenty-nine patients with VH and repeat negative urinalysis on assessment had a positive urine culture suggesting a UTI as a cause. None of these patients was found to have urothelial cancer ( p = 0.0413). Conclusion: Patients who experience transient VH and subsequent repeat negative urinalysis in the absence of infection have a 5% chance of urothelial cancer and should still be investigated. For those with transient NVH, the probability of finding a urothelial cancer is <1%, although we did find a high-grade bladder tumour in this group. If patients have a positive urine culture and a negative repeat urinalysis following treatment, they could be spared haematuria investigations.

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Pregnancy outcome following bacteriuria in pregnancy and the significance of nitrites in urinalysis – a retrospective cohort study

Journal of Perinatal Medicine ◽

10.1515/jpm-2018-0428 ◽

2019 ◽

Vol 47 (6) ◽

pp. 611-618

Author(s):

Eviatar Naamany ◽

Irit Ayalon-Dangur ◽

Eran Hadar ◽

Iftach Sagy ◽

Dafna Yahav ◽

...

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Retrospective Cohort Study ◽

Pregnancy Outcomes ◽

Retrospective Cohort ◽

Urine Culture ◽

Premature Delivery ◽

Positive Urine Culture ◽

Positive Urine ◽

Adverse Pregnancy

Abstract Background The association between bacteriuria and adverse pregnancy outcomes has been extensively described. The current practice of screening all pregnant women for bacteriuria is challenged by recent studies. We aimed to evaluate pregnancy outcomes among women with a positive urine culture, to assess the significance of positive urinary nitrites in this setting. Methods This was a retrospective cohort study at the emergency department (ED) of the Helen Schneider Hospital for Women, Israel, during 2014–2018. This included all gravida women >18 years old within the 20th week of pregnancy or above, admitted to the ED with diverse complains, who had urinalysis collected and subsequently had a positive urine culture. Clinical and obstetric characteristics were stratified by positive vs. negative nitrites in urinalysis. The primary outcome was premature delivery, and the secondary outcomes were a composite outcome of all recorded pregnancy complications and the significance of urinalysis in predicting urinary tract infection (UTI). Results Overall, 874 pregnant women with a positive urine culture were included. Of them, 721 (79%) patients had a negative nitrite in their urine exam (NNU-group) and 153 (21%) had a positive nitrite in their urine exam (PNU-group). Escherichia coli was the most common pathogen, with significantly higher rates of growth in the PNU-group vs. NNU-group [129 (84.3%) vs. 227 (38.4%), P < 0.001]. Premature delivery was recorded with no association of symptomaticity or nitrite status. Among symptomatic women with classic symptoms of UTI, PNU was significantly associated with decreased risk for major peripartum complications [odds ratio (OR) with 95% confidence interval (CI) of 0.22 (0.05–0.94)]. Conclusion Our findings support that PNU among symptomatic pregnant women with UTI-related symptoms was associated with lower risk of developing major adverse obstetrical outcomes.

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Incidence of Acute Pyelonephritis in Hospitalized Children under 5 Years Old with Positive Urine Culture

Universitas Médica ◽

10.11144/javeriana.umed59-4.piel ◽

2018 ◽

Vol 59 (4) ◽

pp. 1-5

Author(s):

Alexandra Castaño González ◽

Juan Gabriel Ruiz Peláez

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Acute Pyelonephritis ◽

Urine Culture ◽

Renal Scintigraphy ◽

Hospitalized Children ◽

Positive Urine Culture ◽

Positive Urine ◽

Urinary Culture

Introduction: Urinary tract infection is a major cause of child morbidity. The diagnosis of acute pyelonephritis is important to decide the treatment. Methods: Retrospective observational study. We collected information of urinalysis, urine Gram and urine culture of hospitalized children between 3 months and 5 years old, with suspected urinary tract infection between January 2008 and December 2010. In patients with positive urine culture, the results of renal scintigraphy (Gamma scan) were evaluated to estimate the incidence of acute pyelonephritis. Results: We identified 1,463 medical records. Urinary culture was obtained in 237 patients, of whom 54.4% were positive. Renal scintigraphy was obtained in 93 of these patients and 59.1% were positive. Conclusions: The incidence of acute pyelonephritis in patients with confirmed urinary tract infection was 59.1%.

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Impact of Constipation in Children on Urinary Tract Infection (UTI)

Bangladesh Journal of Child Health ◽

10.3329/bjch.v34i1.5697 ◽

1970 ◽

Vol 34 (1) ◽

pp. 17-20 ◽

Cited By ~ 1

Author(s):

Seikh Azimul Hoque ◽

Md Tariqul Islam ◽

Farid Ahmed ◽

Mohammed Hanif ◽

Shahnoor Islam ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urine Culture ◽

Single Species ◽

Control Group ◽

Positive Urine Culture ◽

Positive Urine ◽

History Of ◽

The Difference

Objectives: The study was done to find out the relationship between constipation andurinary tract infection (UTI) in children.Methods: The study was a case control study between two groups in a tertiary carechildren hospital in Dhaka city. In group-1 (n=45) those children having history ofconstipation and in group-2 (n=78) as a control group having no history of constipationwere included in this study. Growths of a single species of organism with colony countof >105/ml in a clean-catch midstream single urine sample was considered as evidenceof urinary tract infection.Results: Positive urine culture was found in 8.9% (4/45) cases in children who hadhistory of constipation and 1.3% (1/78) in children who had no history of constipation.Though the number of positive urine culture was seven times more in children withconstipation than those who were not constipated but the difference between the twogroups was not statistically significant (p=0.059) .Conclusion: Culture documented UTI in children with constipation is seven timesmore than without constipation showing impact of constipation on urinary tract infection(UTI) in children.Key words: Urinary tract infection (UTI); constipation.DOI: 10.3329/bjch.v34i1.5697Bangladesh Journal of Child Health 2010; Vol.34(1): 17-20

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