Development of a score based on urinalysis to improve the management of urinary tract infection in children

Rosa Luciano, Simone Piga, Leonardo Federico, Marta Argentieri, Francesca Fina, Marina Cuttini, Emilia Misirocchi, Francesco Emma, Maurizio Muraca

Research output: Contribution to journalArticlepeer-review


Background: The need for reducing unnecessary antibiotic treatment is being emphasized in the management of urinary tract infections (UTI), a disease frequent in childhood. An ideal test should provide early diagnosis without the waiting times of urine culture, but even a simple test of exclusion could significantly improve patient management. Methods: We evaluated the sensitivity, specificity, negative and positive predictive value of automated microscopy IRIS iQ200 combined with the dipstick analyses in children with suspected UTI. Multivariable logistic regression analysis was used to identify the set of variables that best predict positive culture results and develop a numerical risk score. Results: Of 474 consecutive urine samples retrospectively analyzed, 69 were positive at urine culture with prevalence of infection of 14.6%. Parameters significantly associated with the presence of infection in multivariable analysis were age <1. year (p. <0.001), leukocyte esterase. ≥ 15. ≥ 10^6/L (p. <0.001), number of small particles (ASP) ≥ 5500. ≥ 10^6/L (p. <0.001) and bacteria. ≥ 3. ≥ 10^6/L (p = 0.01). The derived score ranged from 0 to 10, with higher values indicating higher risk of UTI. The area under the score ROC curve was 79% (95% CI 0.72-0.85), and was better than those of the individual urinary chemical and microscopic analyses. Conclusions: This routine method could improve the management of UTI in children by early identifying patients with low probability of infection, for whom antibiotic treatment can be withheld until the results of urine culture become available.

Original languageEnglish
Pages (from-to)478-482
Number of pages5
JournalClinica Chimica Acta
Issue number3-4
Publication statusPublished - Feb 18 2012


  • Urinalysis
  • Urinary sediment
  • Urinary tract infection

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Biochemistry, medical


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