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Urine Testing for the Detection of Urinary Tract Infections in Febrile Pediatric Cancer Patients Presenting to the ED

Rola Cheaito, Rasha D. Sawaya, Hani Tamim, Ola El Kebbi, Mohamed Elsakati, Mahmood Kishta, Abdulla Mohamed Almarzooqi5, Imad El Majzoub*

Introduction: Urinary Tract Infections (UTIs) are prevalent in pediatric cancer patients, but usually present vaguely, with non-localizing signs and symptoms (i.e., with fever but without urinary symptoms), especially in the setting of febrile neutropenia, rendering the diagnosis challenging. There is still much controversy when it comes to the indications of urine testing in pediatric cancer patients presenting with fever, but without urinary signs or symptoms.

Objectives: Our aim was to determine the value of obtaining a Urine Culture (UC) in pediatric cancer patients presenting with fever only, as well as to evaluate the diagnostic performance of a Urine Analysis (UA) in this group.

Methods: This was a retrospective cohort study conducted on asymptomatic pediatric cancer patients presenting to our Emergency Department (ED) solely with fever, over a period of five years.

Results: A total of 301 patients were included in this study. The mean age was 7.98 ± 4.98 years. A patient with a positive UC was more likely to be a female (p<0.001) and to have a liquid tumor (p=0.024). More than half of the patients with a positive UC had a negative UA (p<0.001). A UA was found to be 44.8% sensitive and 90.4% specific for the diagnosis of a UTI in the studied population, with a positive predictive value of 33.3% and a negative predictive value of 93.9%.

Conclusion: A positive UC remains the gold standard and classical method for the diagnosis of a UTI in all patients in general, and in febrile pediatric cancer patients in specific. Although cheaper and more timesaving, a UA has a very limited role in making an absolute diagnosis when compared to a UC.