Clinical and laboratory observationsWhat Urinary Colony Count Indicates a Urinary Tract Infection in Children?
Section snippets
Methods
Application of the stringent RIVUR primary outcome definition was standardized by an independent UTI classification committee.2 Specifically, a recurrent UTI required a culture-proven infection with a single organism ≥50 000 CFU/mL (catheterized or SPA urine) or ≥100 000 CFU/mL (clean-voided); pyuria on microscopic urinalysis (≥5 wbc/mm in an uncentrifuged specimen or ≥10 wbc/hpf in a centrifuged specimen), or trace or greater leukocyte esterase on dipstick; and fever (38°C or greater) or
Results
In the RIVUR trial, 111 of the enrolled 607 children had 171 recurrent UTIs that met the original protocol-specified criteria.1, 2 (Table; available at www.jpeds.com) No additional children would have been diagnosed with a recurrent UTI if the culture criteria for a clean caught urine was dropped from >100 000 CFU/mL to ≥50 000 CFU/mL. One 8-month-old and 1 child older than 24 months, both of whom were receiving antibiotic prophylaxis, would have been diagnosed with a recurrent UTI if the
Discussion
Changing the colony count cut-off for diagnosis of a recurrent UTI in the RIVUR trial to ≥10 000 CFU/mL in children with symptoms and pyuria adds only 2 UTI diagnoses, has minimal impact on specificity, and makes no difference in the conclusions of the RIVUR study. This lower threshold is consistent with the European guidelines and suggests that serious consideration be given to decreasing the bacteriologic criterion for a UTI in the American Academy of Pediatrics and Canadian guidelines to
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The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Study was conducted by the RIVUR investigators supported by grants U01 DK074059, U01 DK074053, U01 DK074082, U01 DK074064, U01 DK074062, U01 DK074063 from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health. The authors declare no conflicts of interest.