Reconsidering asymptomatic bacteriuria and contamination as causes of bacteriuria without pyuria

      Shaikh et al performed a meta-analysis to determine the prevalence of asymptomatic bacteriuria in children.
      • Shaikh N.
      • Osio V.A.
      • Wessel C.B.
      • Jeong J.H.
      Prevalence of asymptomatic bacteriuria in children: a meta-analysis.
      The clinical issue is whether a positive urine culture with a negative urinalysis represents a urinary tract infection (UTI) or asymptomatic bacteriuria. The authors calculate the rate of bacteriuria without pyuria (the working definition of asymptomatic bacteriuria) to be 0.18% in boys and 0.38% in girls. They compare these rates with the 5% rate of what they call “UTIs,” determine the rate of asymptomatic bacteriuria to be “at least an order of magnitude less than the prevalence of UTI,” and conclude that “the current definition of UTI should be revisited.”
      • Shaikh N.
      • Osio V.A.
      • Wessel C.B.
      • Jeong J.H.
      Prevalence of asymptomatic bacteriuria in children: a meta-analysis.
      However, the majority of the 5% have both bacteriuria and pyuria and clearly have a UTI, not asymptomatic bacteriuria. It is the remainder of the 5%—the 5%-15% with bacteriuria without pyuria—that should be compared with the prevalence of asymptomatic bacteriuria. Because 5%-15% of 5% is 0.25-0.75%, the rate in febrile children is similar to the prevalence of asymptomatic bacteriuria calculated by Shaikh et al.

      References

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        Prevalence of asymptomatic bacteriuria in children: a meta-analysis.
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      Linked Article

      • Prevalence of Asymptomatic Bacteriuria in Children: A Meta-Analysis
        The Journal of PediatricsVol. 217
        • In Brief
          To determine the point prevalence of bacteriuria and bacteriuria without pyuria in asymptomatic children by a systematic review of the literature.
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      • Editors' Response
        The Journal of PediatricsVol. 223
        • In Brief
          We take this opportunity to comment on the letter to the editor from Drs Roberts and Wald, questioning the validity of the analysis and conclusion of the manuscript by Shaikh et al, and the authors' response. We believe that the analysis performed by Shaikh et al is sound and stand by the decision of The Journal to publish their study. We also choose to publish the letter and response to further enrich the deliberations of our readers.
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      • Reply
        The Journal of PediatricsVol. 223
        • In Brief
          We thank Drs Roberts and Wald for their interest in our article. However, the calculations presented in the first paragraph of their letter are misleading because they assume the “best case scenario” in favor of the authors' argument. Only when both prevalence of urinary tract infection (UTI) and false positive rate of on currently-available point-of-care tests for pyuria are 5% would the prevalence of true missed UTI without pyuria (ie, 0.25%) approach that of asymptomatic bacteriuria without pyuria (0.21%, the overall rate of asymptomatic bacteriuria without pyuria from our study).
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