Shaikh et al performed a meta-analysis to determine the prevalence of asymptomatic bacteriuria in children.
1The 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.”
1However, 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.
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Published online: May 21, 2020
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