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Background Emergency departments (EDs) often rely on urinalysis (UA) to rapidly identify urinary tract infections (UTIs) in children. However, the suboptimal test characteristics of UA can lead to false-positive results. Novel urinary biomarkers may increase the diagnostic precision of UA. In this study, we compared the concentrations of 6 pre-selected proteins: BH3 interacting domain death agonist (BID), B-cell lymphoma 6 protein, ras GTPase-activating protein 1, cathepsin S (CTSS), 3-hydroxyanthranilate 3,4-dioxygenase, and transgelin-2. Methods In a pediatric ED, we prospectively enrolled 167 children with UA and urine culture collected. Pyuria was defined as either [greater than or equal to] 5 white blood cells per high-power field on microscopy or positive leukocyte esterase (LE). The urine culture was considered positive if it yielded [greater than or equal to] 50,000 colony-forming units per milliliter of any single urinary pathogen. Urine protein levels were measured by enzyme-linked immunosorbent assay and normalized to urine creatinine. Results BID was significantly higher in the UTI group compared to the culture-negative pyuria group with a mean ratio of 1.42 (95% confidence interval (CI), 1.15, 1.76) when uncorrected for creatinine concentration. When corrected for creatinine concentration, CTSS was significantly elevated in the UTI group compared to the culture-negative pyuria group with a mean ratio of 2.11 (95% CI, 1.39, 3.21). Conclusions BID and CTSS concentrations were elevated in the urine of children with UTI compared to those with culture-negative pyuria. These proteins deserve further research into their utility to serve as novel biomarkers for UTI. Graphical abstract, Author(s): Elaise B Hill [sup.1] [sup.2] , Joshua R Watson [sup.3] , Daniel M Cohen [sup.1] , David Kline [sup.4] , Andrew L Schwaderer [sup.5] , John D Spencer [sup.6] [...]

Background This study aimed to assess predictors for grade 3-5 vesicoureteral reflux (VUR) in infants [less than or equal to] 2 months of age admitted for first urinary tract infection (UTI). Methods Retrospective cohort study of 195 infants [less than or equal to] 2 months admitted to a pediatric ward for first UTI between 2006 and 2017. Clinical, laboratory, and imaging data were collected from electronic medical charts. We examined associations between grade 3-5 VUR and different patient characteristics. Results Twenty infants (10%) were diagnosed with grade 3-5 VUR; all had fever. Infants with grade 3-5 VUR had higher blood neutrophil percentage (BNP) (65% vs. 46%, P < 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (2.6 vs. 1.3, P < 0.001), more renal ultrasound abnormalities (prenatal 26% vs. 5%, P = 0.007; postnatal 84% vs. 55%, P = 0.015), and Pseudomonas UTI (15% vs. 1%, respectively, P 1.65 showed sensitivity 100% and specificity 61% for detecting grade 3-5 VUR. BNP > 53% showed sensitivity 100% and specificity 60% for detecting grade 3-5 VUR. BNP was the best single marker for grade 3-5 VUR with area under the curve (AUC) of 0.82 (95% CI 0.75-0.89). In a multivariate model, AUC for combination of BNP and hydronephrosis was 0.86 (95% CI 0.79-0.93, P = 0.007). Conclusions Infants [less than or equal to] 2 months of age admitted for a first UTI are at risk for grade 3-5 VUR and thus should undergo a voiding cystourethrography (VCUG) if their renal ultrasound is abnormal or if they have Pseudomonas UTI. Avoiding VCUG can be considered in afebrile infants and in infants with BNP < 53% or NLR < 1.65., Author(s): Hilla Bahat [sup.1] [sup.2] , Mai Ben-Ari [sup.1] , Tomer Ziv-Baran [sup.2] [sup.3] , Amos Neheman [sup.2] [sup.4] , Ilan Youngster [sup.1] [sup.2] , Michael Goldman [sup.1] [sup.2] Author [...]

A nurse-led study has raised concerns about the proportion of people with continence problems who could have an undiagnosed urinary tract infection (UTI). Jenny Price, a community learning disability nurse [...]