RESUMO
The purpose of our study was to characterize the utility of certain elements of urinalysis, singly or in combination, in identifying children with urinary tract infections (i.e., positive findings on urine culture). Laboratory results for urine specimens subjected to both urinalysis and culture in an on-site outpatient clinic (office) laboratory during a 36-month period were reviewed. All specimens were collected by one of three methods (the midstream void technique, urethral catheterization, or suprapubic aspiration of urine) from children with symptoms to assist in documenting a possible urinary tract infection. Specimen processing by certified technologists was initiated within 10 minutes of collection. Sensitivity, specificity, and positive and negative predictive values were determined for each test or combination of tests. Of 689 specimens, 102 (14.8%) had positive culture results. The combination of dipstick analysis (leukocyte esterase and nitrite tests) and of microscopic examination for bacteria had a sensitivity of 100% and a negative predictive value of 100%. The nitrite test had a specificity of 100% and a positive predictive value of 100%. We conclude that, when properly collected specimens are evaluated promptly by certified technologists, the rate of accuracy in detecting or ruling out a urinary tract infection (i.e., positive findings on urine culture) with certain elements of the urinalysis is high.
Assuntos
Infecções Urinárias/urina , Adolescente , Bacteriúria/microbiologia , Bacteriúria/urina , Hidrolases de Éster Carboxílico/urina , Criança , Pré-Escolar , Violeta Genciana , Humanos , Lactente , Leucócitos/patologia , Microscopia de Contraste de Fase , Nitritos/urina , Fenazinas , Valor Preditivo dos Testes , Fitas Reagentes , Sensibilidade e Especificidade , Urinálise , Infecções Urinárias/microbiologiaAssuntos
Aleitamento Materno , Infecções Urinárias , Feminino , Humanos , Lactente , Masculino , Fatores Sexuais , Manejo de Espécimes/métodos , Urinálise/métodosAssuntos
Manejo de Espécimes , Urina/microbiologia , Criança , Pré-Escolar , Desinfecção , Feminino , Humanos , Valores de ReferênciaAssuntos
Circuncisão Masculina , Manejo de Espécimes , Urina/microbiologia , Adolescente , Criança , Pré-Escolar , Desinfecção , Humanos , MasculinoAssuntos
Infecções por Campylobacter/diagnóstico , Enterite/microbiologia , Fezes/microbiologia , Azul de Metileno , Corantes de Rosanilina , Adolescente , Adulto , Campylobacter fetus , Criança , Pré-Escolar , Fezes/citologia , Humanos , Lactente , Microscopia/métodos , Pessoa de Meia-Idade , Neutrófilos/microbiologia , Estudos Prospectivos , Coloração e RotulagemRESUMO
We studied 102 children aged 1 month to 18 years in a randomized, double-blind trial designed to determine both the natural history of bacterial conjunctivitis and whether topical antibiotic therapy is beneficial. Affected eyes were treated four times a day for 7 days with drug (polymyxin-bacitracin ophthalmic ointment) or placebo. Eighty-four patients had proved bacterial conjunctivitis (Haemophilus influenzae 61, Streptococcus pneumoniae 22, both one); 66 of these received only topical therapy. By 3 to 5 days, 21 of 34 (62%) patients receiving topical antibiotic were clinically cured, whereas only nine of 32 (28%) patients given placebo were cured (P less than 0.02). By 8 to 10 days, 31 (91%) of the patients given antibiotic and 23 (72%) of the placebo group were cured (P = NS). The bacterial pathogen was eradicated by day 3 to 5 in 71% and by day 8 to 10 in 79% of patients given antibiotic, compared to 19% and 31% of the placebo group (P less than 0.001). Acute bacterial conjunctivitis is a self-limited disease, but topical antibiotic therapy with polymyxin-bacitracin shortens the duration of clinical disease and enhances eradication of the causative organism from the conjunctiva.
Assuntos
Bacitracina/uso terapêutico , Conjuntivite/tratamento farmacológico , Infecções por Haemophilus/tratamento farmacológico , Infecções Pneumocócicas/tratamento farmacológico , Polimixinas/uso terapêutico , Doença Aguda , Administração Oral , Administração Tópica , Adolescente , Criança , Pré-Escolar , Conjuntivite/microbiologia , Haemophilus influenzae , Humanos , Lactente , PlacebosRESUMO
Forty-nine girls between the ages of 2 and 18 years with a symptomatic urinary tract infection documented by two clean-catch urine cultures completed a double-blind study comparing the effectiveness of three days versus ten days of nitrofurantoin macrocrystal therapy. Localization of the infection to the lower urinary tract was presumed on the basis of clinical presentation. All patients had sterile urine on day two or three of therapy. In the ten-day group, two of 23 patients (8.7%) experienced a single relapse, and seven patients (30%) had 12 episodes of reinfection during a six-month follow-up. In the three-day group, two of 26 patients (7.7%) had a single relapse, and six patients (23%) had 12 episodes of reinfection. The rates of relapse and reinfection in the compared groups were not statistically significantly different (P greater than 0.05). Three days of treatment with nitrofurantoin macrocrystals is an effective regimen for symptomatic girls presumed to have uncomplicated lower urinary tract infections.