Objective To evaluate the need for routine urine studies in children with febrile neutropenia with cancer.
Design A prospective, observational study was conducted in two hospitals between November 2019 and October 2021.
Patients We recruited 205 patients in total.
Main outcome measures The primary outcome was presence of positive urine culture (UC). Urinary tract infection (UTI) was defined as urinary signs/symptoms and positive UC with or without pyuria. A descriptive analysis of data is provided.
We conducted a prospective study of paediatric patients with cancer with urinary continence. Data were analysed using descriptive statistics. The diagnostic performance of urinalysis was calculated using positive UC as the gold standard.
Results Positive UC was found in 7 of the 205 patients (3.4%; 95% CI 1.4% to 6.9%), 2 presenting urinary symptoms. UTI prevalence was 1.0% (95% CI 0.1% to 3.5%). A 23.8% prevalence of positive UC was found in patients with urinary symptoms and/or history of urinary tract disease (95% CI 8.2% to 47.2%) as compared with 1.1% of those without symptoms or history (95% CI 0.1% to 3.9%) (p<0.001). The sensitivity, specificity, negative predictive value, and area under the curve for urinalysis were 16.7% (95% CI 3.0% to 56.4%), 98.4% (95% CI 95.3% to 99.4%), 97.3% (95% CI 93.9% to 98.9%), and 0.65 (95% CI 0.51 to 0.79), respectively.
Conclusions UTI is an infrequent cause of infection in these patients. Urinalysis is indicated only in children with febrile neutropenia with urinary signs/symptoms and in asymptomatic patients with a history of urinary tract disease or unknown history. When urine is collected, UC should be requested regardless of the result of the urinalysis.
- Paediatric Emergency Medicine
- Infectious Disease Medicine
Data availability statement
Data are available upon reasonable request. No data are available.
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Contributors JAAC contributed to the study conception and design, material preparation and analysis, wrote the first draft of the manuscript and act as the guarantor. BH, AL and MdlT conceptualised and designed the study, coordinated and supervised the data collection, and critically reviewed the manuscript. The following doctors revised the data collection form, collected data and critically reviewed the manuscript—MSR, ELC and RR.
Funding This work was supported by the Spanish Pediatric Emergency Research Group (SPERG) grant year 2019.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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