Screening for urinary tract infection in infants in the emergency department: which test is best?

Pediatrics. 1998 Jun;101(6):E1. doi: 10.1542/peds.101.6.e1.


Objective: Comparison of rapid tests and screening strategies for detecting urinary tract infection (UTI) in infants.

Methods: Cross-sectional study conducted in an urban tertiary care children's hospital emergency department and clinical laboratories of 3873 infants <2 years of age who had a urine culture obtained in the emergency department by urethral catheterization; results of urine dipstick tests for leukocyte esterase or nitrites, enhanced urinalysis (UA) (urine white blood cell count/mm3 plus Gram stain), Gram stain alone, and dipstick plus microscopic UA (white blood cells and bacteria per high-powered field) compared with urine culture results (positive urine results defined as >/=10 colony-forming units per milliliter of urinary tract pathogen) for each sample. Cost comparison of 1) dipstick plus culture of all urine specimens versus 2) cell count +/- Gram stain of urine, culture only those with positive results.

Results: The enhanced UA was most sensitive at detecting UTI (94%; 95% confidence interval: 83,99), but had more false-positive results (16%) than the urine dipstick or Gram stain (3%). The most cost-effective strategy was to perform cultures on all infants and begin presumptive treatment on those whose dipstick had at least moderate (+2) leukocyte esterase or positive nitrite at a cost of $3.70 per child. With this strategy, all infants with UTI were detected. If the enhanced UA was used to screen for when to send the urine for culture, 82% of cultures would be eliminated, but 4% to 6% of infants with UTI would be missed and the cost would be higher ($6.66 per child).

Conclusion: No rapid test can detect all infants with UTI. Physicians should send urine for culture from all infants and begin presumptive treatment only on those with a significantly positive dipstick result. The enhanced UA is most sensitive for detecting UTI, but is less specific and more costly, and should be reserved for the neonate for whom a UTI should not be missed at first visit.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bacteriological Techniques / economics
  • Cross-Sectional Studies
  • Emergency Service, Hospital / economics
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Infant
  • Leukocyte Count
  • Male
  • Predictive Value of Tests
  • Prospective Studies
  • Reagent Strips / economics
  • Sensitivity and Specificity
  • Urinalysis / economics
  • Urinalysis / methods*
  • Urinary Tract Infections / diagnosis*
  • Urine / chemistry
  • Urine / microbiology


  • Reagent Strips