Association of Diagnostic Criteria with Urinary Tract Infection Prevalence in Bronchiolitis: A Systematic Review and Meta-analysis

Corrie E. McDaniel, Shawn Ralston, Brian Lucas, Alan R. Schroeder

Research output: Contribution to journalReview article

Abstract

Importance: Concomitant urinary tract infection (UTI) is a frequent concern in febrile infants with bronchiolitis, with a prior meta-analysis suggesting a prevalence of 3.3%. However, the definition of UTI in these studies has generally not incorporated urinalysis (UA) results. Objective: To conduct a systematic review and meta-analysis examining the prevalence of UTI in infants with bronchiolitis when positive UA results are incorporated into the UTI definition. Data Sources: Medline (1946-2017) and Ovid EMBASE (1976-2017) through August 2017 and bibliographies of retrieved articles. Study Selection: Studies reporting UTI prevalence in bronchiolitis. Data Extraction: Data were extracted in accordance with meta-analysis of observational studies in epidemiology guidelines via independent abstraction by multiple investigators. Random-effects models generated a weighted pooled event rate with corresponding 95% confidence intervals. Main Outcomes and Measures: Prevalence of UTI. Results: We screened 477 unique articles by abstract, with full-text review of 30 studies. Eighteen bronchiolitis studies reported a UTI prevalence and 7 of these reported UA data for inclusion in the meta-analysis. The overall reported prevalence of UTI in bronchiolitis from these 18 studies was 3.1% (95% CI, 1.8%-4.6%). With the addition of positive UA results (defined as the presence of pyuria or nitrites) as a diagnostic criterion, the prevalence of UTI as reported in the 7 studies in bronchiolitis was 0.8% (95% CI, 0.3%-1.4%). Sensitivity analyses yielded similar results, including for infants younger than 90 days. Heterogeneous definitions of UTI and UA criteria introduced uncertainty into prevalence estimates. Conclusions and Relevance: When a positive UA result is added as a diagnostic criterion, the estimated prevalence of concomitant UTI is less than recommended testing thresholds for bronchiolitis.

Original languageEnglish (US)
Pages (from-to)269-277
Number of pages9
JournalJAMA pediatrics
Volume173
Issue number3
DOIs
StatePublished - Mar 1 2019
Externally publishedYes

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Bronchiolitis
Urinary Tract Infections
Meta-Analysis
Urinalysis
Pyuria
Information Storage and Retrieval
Bibliography
Nitrites
Uncertainty
Observational Studies
Epidemiology
Fever
Research Personnel
Outcome Assessment (Health Care)
Guidelines
Confidence Intervals

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Association of Diagnostic Criteria with Urinary Tract Infection Prevalence in Bronchiolitis : A Systematic Review and Meta-analysis. / McDaniel, Corrie E.; Ralston, Shawn; Lucas, Brian; Schroeder, Alan R.

In: JAMA pediatrics, Vol. 173, No. 3, 01.03.2019, p. 269-277.

Research output: Contribution to journalReview article

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abstract = "Importance: Concomitant urinary tract infection (UTI) is a frequent concern in febrile infants with bronchiolitis, with a prior meta-analysis suggesting a prevalence of 3.3{\%}. However, the definition of UTI in these studies has generally not incorporated urinalysis (UA) results. Objective: To conduct a systematic review and meta-analysis examining the prevalence of UTI in infants with bronchiolitis when positive UA results are incorporated into the UTI definition. Data Sources: Medline (1946-2017) and Ovid EMBASE (1976-2017) through August 2017 and bibliographies of retrieved articles. Study Selection: Studies reporting UTI prevalence in bronchiolitis. Data Extraction: Data were extracted in accordance with meta-analysis of observational studies in epidemiology guidelines via independent abstraction by multiple investigators. Random-effects models generated a weighted pooled event rate with corresponding 95{\%} confidence intervals. Main Outcomes and Measures: Prevalence of UTI. Results: We screened 477 unique articles by abstract, with full-text review of 30 studies. Eighteen bronchiolitis studies reported a UTI prevalence and 7 of these reported UA data for inclusion in the meta-analysis. The overall reported prevalence of UTI in bronchiolitis from these 18 studies was 3.1{\%} (95{\%} CI, 1.8{\%}-4.6{\%}). With the addition of positive UA results (defined as the presence of pyuria or nitrites) as a diagnostic criterion, the prevalence of UTI as reported in the 7 studies in bronchiolitis was 0.8{\%} (95{\%} CI, 0.3{\%}-1.4{\%}). Sensitivity analyses yielded similar results, including for infants younger than 90 days. Heterogeneous definitions of UTI and UA criteria introduced uncertainty into prevalence estimates. Conclusions and Relevance: When a positive UA result is added as a diagnostic criterion, the estimated prevalence of concomitant UTI is less than recommended testing thresholds for bronchiolitis.",
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