Source:
Investigators from multiple institutions conducted a meta-analysis to evaluate the prevalence of urinary tract infection (UTI) in infants with jaundice, and the estimated prevalence when urinalysis (UA) results were included as a diagnostic criterion. A systematic review process was used to identify studies that included an estimated prevalence rate of UTI in infants with a primary diagnosis of neonatal jaundice. For the included studies, a child was classified as having a UTI based on the authors’ definition, and the definition of jaundice was based on an elevated bilirubin level or a determination of “clinical jaundice.” Studies were reviewed to determine if UA results had been obtained on patients with UTI. Classification of a positive UA was based on the authors’ determination. Data from the included studies were extracted, and random effects models were used to produce a pooled prevalence estimate. The prevalence of UTI among infants with jaundice was calculated using data from all studies, limited to infants in studies that included UA results, and when a positive UA was required to diagnose UTI.
Data from 32 studies were included in the meta-analysis. Of these, 16 included UA results, and 16 had no data on UA. In the 16 studies without UA results, 7 included infants with “clinical jaundice” without bilirubin results; the remaining studies included patients with elevated unconjugated bilirubin levels. Among the 16 studies with UA data, 3 included patients with “clinical jaundice,” and the remaining 13 defined jaundice based on elevated unconjugated bilirubin levels; 3 studies included patients with conjugated hyperbilirubinemia. Criteria for a diagnosis of UTI ranged from any bacterial growth on culture to >100,000 colony forming units/mL from a sample obtained by suprapubic aspiration. Two studies included mixed organisms in urine culture results, and in some studies no specific definition of UTI was provided. For studies that included UA data, the definitions of positive results included “presence of pyuria,” positive leukocyte esterase results, or specific white blood cell counts per high-power field.
Using data from all 32 included studies, the pooled UTI prevalence in jaundiced infants was 6.2% (95% CI, 3.9%, 8.9%). When limiting the analysis to data from studies that included UA results, the calculated UTI prevalence was 8.7% (95% CI, 5.1%, 13.2%), and, if a diagnosis of UTI required a positive UA, the prevalence was estimated at 3.6% (95% CI, 2.0%, 5.8%).
The authors conclude that when a positive UA is required as a diagnostic criterion for UTI in jaundiced infants, the estimated prevalence decreases substantially. However, due to the heterogeneity in the studies for definitions of jaundice, UTI, and a positive UA, the exact prevalence is uncertain.
Dr Alissa has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an...
Comments