Why Are Children With Bronchiolitis At Risk Of Urinary Tract Infections?

Hendaus, Mohamed A

In a review of the literature, the percentage of patients with fever with positive urine cultures ranged from 4.2% to 20.0% in infants <3 months of age and 0% to 7.4% in older children (3 to 36 months of age). 14 Ralston et al 3 conducted a systematic review delineating the risk of occult SBI in young febrile infants presenting with either "clinical bronchiolitis" or "proven RSV infection". The review included 11 studies. [4] [5] [6] [7] [9] [10] [11] [12] [13] 15, 16 The rate of urinary tract infections in the 11 studies analyzed was 3.3% (95% confidence interval, 1.9-5.7%). The authors concluded the rate of urine cultures positive for bacteria was noteworthy, though asymptomatic bacteriuria may have muddled the results. Recently, McDaniel et al 17 conducted a systematic review and meta-analysis exploring the prevalence of UTI in infants and young children with bronchiolitis when positive urinalysis (UA) results being incorporated into the UTI definition. The investigators included 18 studies, [4] [5] [6] [7] 9, [11] [12] [13] 15, 16, [18] [19] [20] [21] [22] [23] [24] [25] seven of which had UA information. 4, 11, 16, 18, [20] [21] [22] The definition of positive UA varied among the studies. Some considered positive UA as having more than 5 white blood cells per high-powered field, while others considered the UA positive by having bacteriuria, positive leukocyte esterase, or positive nitrite. The prevalence of UTI in bronchiolitis in the 18 studies was 3.1% (95% CI, 1.8-4.6%). The authors further analyzed the data of the 7 studies where the presence of pyuria or nitrites was a diagnostic criterion to define UTI and the prevalence of UTI was 0.8% (95% CI, 0.3-1.4%).