Prevalence of Urinary Tract Infection in Childhood: A Meta-Analysis
Prevalence of Urinary Tract Infection in Childhood: A Meta-Analysis
Background: Knowledge of baseline risk of urinary tract infection can help clinicians make informed diagnostic and therapeutic decisions. We conducted a meta-analysis to determine the pooled prevalence of urinary tract infection (UTI) in children by age, gender, race, and circumcision status.
Methods: MEDLINE and EMBASE databases were searched for articles about pediatric urinary tract infection. Search terms included urinary tract infection, cystitis, pyelonephritis, prevalence and incidence. We included articles in our review if they contained data on the prevalence of UTI in children 0-19 years of age presenting with symptoms of UTI. Of the 51 articles with data on UTI prevalence, 18 met all inclusion criteria. Two evaluators independently reviewed, rated, and abstracted data from each article.
Results: Among infants presenting with fever, the overall prevalence (and 95% confidence interval) of UTI was 7.0% (CI: 5.5-8.4). The pooled prevalence rates of febrile UTIs in females aged 0-3 months, 3-6 months, 6-12 months, and >12 months was 7.5%, 5.7%, 8.3%, and 2.1% respectively. Among febrile male infants less than 3 months of age, 2.4% (CI: 1.4-3.5) of circumcised males and 20.1% (CI: 16.8-23.4) of uncircumcised males had a UTI. For the 4 studies that reported UTI prevalence by race, UTI rates were higher among white infants 8.0% (CI: 5.1-11.0) than among black infants 4.7% (CI: 2.1-7.3). Among older children (<19 years) with urinary symptoms, the pooled prevalence of UTI (both febrile and afebrile) was 7.8% (CI: 6.6-8.9).
Conclusions: Prevalence rates of UTI varied by age, gender, race, and circumcision status. Uncircumcised male infants less than 3 months of age and females less than 12 months of age had the highest baseline prevalence of UTI. Prevalence estimates can help clinicians make informed decisions regarding diagnostic testing in children presenting with signs and symptoms of urinary tract infection.
Pediatric urinary tract infections (UTI) account for 0.7% of physician office visits and 5-14% of emergency department visits by children annually. Accurate diagnosis of UTI has important clinical implications; most febrile infants with UTI show evidence of renal parenchymal involvement (pyelonephritis). Nevertheless, the presenting signs and symptoms of UTI in childhood are often nonspecific and, among infants, definitive testing for UTI involves bladder catheterization. Accordingly, clinicians caring for young children are frequently faced with the decision of whether or not to obtain a urine sample for urinalysis and culture.
Knowledge of the prevalence of UTI among different subgroups of children can assist clinicians in selecting children who would benefit from further diagnostic testing. Using prevalence rates as an estimate of the prior probability of disease is the first step in evidence-based practice. In children with a very low pretest probability of disease, routine diagnostic testing is not necessary. In fact, in such children, an indiscriminate approach to diagnostic testing might lead to more harm than benefit. In contrast, in children with high pretest probability of disease, routine diagnostic testing would be appropriate. In a survey of 300 academic and community pediatricians regarding diagnostic testing in infants with unexplained fever, baseline risk was important in determining diagnostic decisions. Specifically, only 10% of clinicians believed that a urine culture was indicated if the probability of UTI was <1%, whereas 80-90% would obtain a culture if the probability of disease was 3-5%, and all would do so if the probability exceeded 5%. Whether a certain child has a 2% or a 10% baseline probability of UTI makes a difference to the practicing clinician.
Prevalence was defined as the proportion of children with the target disorder among patients undergoing diagnostic testing. This type of point prevalence, also known as pretest probability, provides clinicians with an estimate of the baseline risk of disease.
There are currently no pooled data available stratifying prevalence based on age, gender, race, or circumcision status, all of which can affect UTI risk. To address this we conducted a meta-analysis with the aim of providing clinicians with quantitative estimates of UTI prevalence for each subgroup.
Background: Knowledge of baseline risk of urinary tract infection can help clinicians make informed diagnostic and therapeutic decisions. We conducted a meta-analysis to determine the pooled prevalence of urinary tract infection (UTI) in children by age, gender, race, and circumcision status.
Methods: MEDLINE and EMBASE databases were searched for articles about pediatric urinary tract infection. Search terms included urinary tract infection, cystitis, pyelonephritis, prevalence and incidence. We included articles in our review if they contained data on the prevalence of UTI in children 0-19 years of age presenting with symptoms of UTI. Of the 51 articles with data on UTI prevalence, 18 met all inclusion criteria. Two evaluators independently reviewed, rated, and abstracted data from each article.
Results: Among infants presenting with fever, the overall prevalence (and 95% confidence interval) of UTI was 7.0% (CI: 5.5-8.4). The pooled prevalence rates of febrile UTIs in females aged 0-3 months, 3-6 months, 6-12 months, and >12 months was 7.5%, 5.7%, 8.3%, and 2.1% respectively. Among febrile male infants less than 3 months of age, 2.4% (CI: 1.4-3.5) of circumcised males and 20.1% (CI: 16.8-23.4) of uncircumcised males had a UTI. For the 4 studies that reported UTI prevalence by race, UTI rates were higher among white infants 8.0% (CI: 5.1-11.0) than among black infants 4.7% (CI: 2.1-7.3). Among older children (<19 years) with urinary symptoms, the pooled prevalence of UTI (both febrile and afebrile) was 7.8% (CI: 6.6-8.9).
Conclusions: Prevalence rates of UTI varied by age, gender, race, and circumcision status. Uncircumcised male infants less than 3 months of age and females less than 12 months of age had the highest baseline prevalence of UTI. Prevalence estimates can help clinicians make informed decisions regarding diagnostic testing in children presenting with signs and symptoms of urinary tract infection.
Pediatric urinary tract infections (UTI) account for 0.7% of physician office visits and 5-14% of emergency department visits by children annually. Accurate diagnosis of UTI has important clinical implications; most febrile infants with UTI show evidence of renal parenchymal involvement (pyelonephritis). Nevertheless, the presenting signs and symptoms of UTI in childhood are often nonspecific and, among infants, definitive testing for UTI involves bladder catheterization. Accordingly, clinicians caring for young children are frequently faced with the decision of whether or not to obtain a urine sample for urinalysis and culture.
Knowledge of the prevalence of UTI among different subgroups of children can assist clinicians in selecting children who would benefit from further diagnostic testing. Using prevalence rates as an estimate of the prior probability of disease is the first step in evidence-based practice. In children with a very low pretest probability of disease, routine diagnostic testing is not necessary. In fact, in such children, an indiscriminate approach to diagnostic testing might lead to more harm than benefit. In contrast, in children with high pretest probability of disease, routine diagnostic testing would be appropriate. In a survey of 300 academic and community pediatricians regarding diagnostic testing in infants with unexplained fever, baseline risk was important in determining diagnostic decisions. Specifically, only 10% of clinicians believed that a urine culture was indicated if the probability of UTI was <1%, whereas 80-90% would obtain a culture if the probability of disease was 3-5%, and all would do so if the probability exceeded 5%. Whether a certain child has a 2% or a 10% baseline probability of UTI makes a difference to the practicing clinician.
Prevalence was defined as the proportion of children with the target disorder among patients undergoing diagnostic testing. This type of point prevalence, also known as pretest probability, provides clinicians with an estimate of the baseline risk of disease.
There are currently no pooled data available stratifying prevalence based on age, gender, race, or circumcision status, all of which can affect UTI risk. To address this we conducted a meta-analysis with the aim of providing clinicians with quantitative estimates of UTI prevalence for each subgroup.
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