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Archivos de Pediatría del Uruguay

Print version ISSN 0004-0584On-line version ISSN 1688-1249


KUSTER, Natalia  and  ROBINO, Luciana. How to interpret suspicion tests and when to start empirical antibiotic therapy for urinary tract infections. Arch. Pediatr. Urug. [online]. 2020, vol.91, n.1, pp.21-28.  Epub Feb 20, 2020. ISSN 0004-0584.


urinary tract infections (UTIs) are a cause of frequent consultation. Nitrites and leukocyte esterase (LE) or leukocytes in urine are suspected markers, but their presence is variable.


determine the validity of the suspicion tests and describe the antibiotic prescription based on the results.

Materials and methods:

descriptive, retrospective study of children with suspected UTIs analyzed with nitrites, EL and urine culture between 2016 and 2018.


137 patients were studied for suspected UTIs, and they were confirmed through urine cultures in 27 (19.7%). The main reason for suspected UTIs was fever of unknown origin (FUO) for children aged one month to 3 years of age, and leukocyte / LE sensitivity was 75%, specificity 65.6%, PPV 35.2% and NPV 91.3%. In the case of nitrites and LE the sensitivity was 43.7%, specificity 93.7%, PPV 63.6% and NPV 87%. For children of over 3 years of age, fever and urinary symptoms were the most frequent suspicion of UTI, but they showed low diagnostic sensitivity. Leukocyte sensitivity was 72.7%, specificity 72.9%, PPV 38.1% and NPV 92.1%. For leukocytes and nitrites, the sensitivity was 63.6%, specificity 93.7%, PPV 70% and NPV 91.8%. 65% of children of over 1 month of age with suspected UTI received empirical antibiotics. ITUs were confirmed in only 29.6% of those who received antibiotics.


pediatric UTIs are over diagnosed. The symptoms’ low sensitivity and specificity as wekk as suspicion tests lead to an excessive use of antimicrobials.

Keywords : Urinary tract Infections; Anti-bacterial agents.

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