I am writing to the group in an effort to stimulate some discussion about
the recent article published in the electronic pages of Pediatrics
(www.pediatrics.org) by Dr. Shaw, et. al., entitled "Screening for
Urinary Tract Infection in Infants in the Emergency Department: Which Test
The study looked at infants under the age of 2 years who had a
urine culture obtained by catheterization in the ED for evaluation of a
fever. Urine underwent dipstick tests, enhanced urine analysis, gram
stain, standard microscopic examination, and culture. Statistical
evaluation of the above tests and cost analysis were performed. The paper
concluded that it would be more cost effective and more specific if the
urine was sent for culture and only dipstick analysis performed. If the
dipstick result was significantly positive, then one should consider
beginning presumptive treatment of the infant.
Some questions that I would like the group to address are:
1. How is this article going to influence your current clinical practice?
2. Without a gram stain, what empiric antibiotic will one choose in
infants with a significantly positive dipstick?
3. Do you manage all of your presumed UTI's as inpatients, and if so,
will the increased number of false positive dipstick results influence
Any comments concerning the methods and results of this article would be
appreciated as it would help me develop the skills needed to read the
Rustin B. Morse, M.D.
[log in to unmask] (until July 1998)
Children's Hospital of Pittsburgh
Happily, soon to be,
Pediatric Emergency Medicine Fellow
Children's Memorial Hospital
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