ESPN 50th Annual Meeting

ESPN 2017


 
Clinical characteristics of pediatric urinary tract infection with negative urine leukocyte esterase test
SHOJIRO OKAMOTO 1 AYUMI NOGI 2 TAKASHI SAKAMA 1 FUMIO NIIMURA 2 HIROYUKI MOCHIZUKI 2

1- TOKAI UNIVESITY HACHIOJI HOSIPITAL
2- DEPARTMENT OF PEDIATRICS, TOKAI UNIVERSITY
 
Introduction:

Urine dipstick test for leukocyte esterase is known to be negative in some children with culture-positive UTI. In the present study, we retrospectively reviewed the clinical characteristics of culture-positive UTI with negative or positive urine leukocyte esterase test, which would help us to minimize the risk of missing UTI detection based on the negative result of the dipstick test.

Material and methods:

The patients who were diagnosed as UTI based on positive urine culture from April, 2006 through March, 2014 were reviewed. Clinical characteristics including age, gender, laboratory data, clinical course prior to diagnosis and pathogens, were compared between patients with negative and positive urine leukocyte esterase test.

Results:

85 patients (20 females and 65 males) with 86 episodes of UTI were enrolled. Leukocyte esterase tests were negative in 7 UTI episodes, all of which were male cases. No significant differences were recognized in the median age (0.37 and 0.38 years, p=0.583), peripheral WBC count (18600 and 15100/┬Ál, p=0.275) and CRP (5.19 and 5.70 mg/dl, p=0.890) between leukocyte esterase negative and positive episodes of UTI. Mean duration between the onset of fever and diagnosis was significantly longer in leukocyte esterase negative episodes than positive episodes (3.43 and 1.37 days, p=0.015). E. coli was the pathogenic bacteria in 87.3% episodes of leukocyte esterase positive UTIs, while Enterococcus faecalis was not detected in those UTIs. Of note, 5 out of 7 cases (71.4%) of leukocyte esterase negative UTIs were caused by Enterococcus faecalis.

Conclusions:

Our study suggests that Enterococcus faecalis significantly contributes to leukocyte esterase negative UTIs, and associated with the risk of delayed diagnosis of UTI in children.