Association of Diagnostic Criteria With Urinary Tract Infection Prevalence in Bronchiolitis A Systematic Review and Meta-analysis

被引:28
|
作者
McDaniel, Corrie E. [1 ]
Ralston, Shawn [2 ]
Lucas, Brian [3 ,4 ]
Schroeder, Alan R. [5 ]
机构
[1] Univ Washington, Dept Pediat, Seattle Childrens Hosp, Seattle, WA 98195 USA
[2] Dartmouth Coll, Dept Pediat, Childrens Hosp Dartmouth Hitchcock, Geisel Sch Med, Hanover, NH 03755 USA
[3] Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH USA
[4] Dept Med, Lebanon, NH USA
[5] Stanford Univ, Dept Pediat, Sch Med, Stanford, CA 94305 USA
关键词
RESPIRATORY SYNCYTIAL VIRUS; SERIOUS BACTERIAL-INFECTIONS; FEBRILE INFANTS YOUNGER; ANTIBIOTIC EXPOSURE; CHILDREN; RISK; AGE; EPIDEMIOLOGY; URINALYSIS; MANAGEMENT;
D O I
10.1001/jamapediatrics.2018.5091
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
IMPORTANCE Concomitant urinary tract infection (UTI) is a frequent concern in febrile infants with bronchiolitis, with a prior meta-analysis suggesting a prevalence of 3.3%. However, the definition of UTI in these studies has generally not incorporated urinalysis (UA) results. OBJECTIVE To conduct a systematic review and meta-analysis examining the prevalence of UTI in infants with bronchiolitis when positive UA results are incorporated into the UTI definition. DATA SOURCES Medline (1946-2017) and Ovid EMBASE (1976-2017) through August 2017 and bibliographies of retrieved articles. STUDY SELECTION Studies reporting UTI prevalence in bronchiolitis. DATA EXTRACTION Data were extracted in accordance with meta-analysis of observational studies in epidemiology guidelines via independent abstraction by multiple investigators. Random-effects models generated a weighted pooled event rate with corresponding 95% confidence intervals. MAIN OUTCOMES AND MEASURES Prevalence of UTI. RESULTS We screened 477 unique articles by abstract, with full-text review of 30 studies. Eighteen bronchiolitis studies reported a UTI prevalence and 7 of these reported UA data for inclusion in the meta-analysis. The overall reported prevalence of UTI in bronchiolitis from these 18 studies was 3.1% (95% CI, 1.8%-4.6%). With the addition of positive UA results (defined as the presence of pyuria or nitrites) as a diagnostic criterion, the prevalence of UTI as reported in the 7 studies in bronchiolitis was 0.8% (95% CI, 0.3%-1.4%). Sensitivity analyses yielded similar results, including for infants younger than 90 days. Heterogeneous definitions of UTI and UA criteria introduced uncertainty into prevalence estimates. CONCLUSIONS AND RELEVANCE When a positive UA result is added as a diagnostic criterion, the estimated prevalence of concomitant UTI is less than recommended testing thresholds for bronchiolitis.
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页码:269 / 277
页数:9
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