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Original research
Role of urine culture in paediatric patients with cancer with fever and neutropenia: a prospective observational study
  1. Jose Antonio Alonso-Cadenas1,2,
  2. Monica Sancosmed Ron3,
  3. Blanca Herrero4,
  4. Esther Lera Carballo3,
  5. Alvaro Lassaletta5,
  6. Rocio Rodrigo3,
  7. Mercedes de la Torre1,2
  8. On behalf of the Spanish Pediatric Emergency Research Group (RISeuP-SPERG)
  1. 1 Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
  2. 2 Instituto de Investigación Sanitaria Hospital La Princesa, Madrid, Spain
  3. 3 Paediatric Emergency Medicine, Hospital Vall d'Hebron, Barcelona, Spain
  4. 4 Paediatric Oncology Department, Hospital Universitario Niño Jesús, Madrid, Spain
  5. 5 Pediatric Neuro-oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
  1. Correspondence to Dr Jose Antonio Alonso-Cadenas, Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid 28009, Spain; jalonsocadenas{at}gmail.com

Abstract

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.

https://doi.org/10.1136/archdischild-2023-325992

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    Data availability statement

    Data are available upon reasonable request. No data are available.

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    Footnotes

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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