Monday, February 4, 2013

UTI: Yet Another Windmill?

Medicine is full of windmills re-imagined as dragons – and two of the most prominent voices of reason in Emergency Medicine are David Newman and Jerome Hoffman.  This skeptical take on pediatric urinary tract infections is David Newman's latest, which covers content reflective of his SMART EM podcast on the same topic.

The premise of his argument is rather straightforward:

  • There's substantial overlap between UTI and asymptomatic bacteruria, leading to overdiagnosis.
  • Even when the diagnosis is correctly made, prompt treatment does not prevent complications.
The complications in question are urosepsis and renal scarring.  Urosepsis, in David's literature review only results from urinary tract infections from the otherwise immunosuppressed, or in infants with congenital anomalies.  Renal scarring, purportedly from pyelonephritis, has little or controversial evidence in supporting antibiotic use from preventing it.

This will be published in an upcoming issue of Annals of Emergency Medicine.

"Pediatric Urinary Tract Infection: Does the Evidence Support Aggressively Pursuing the Diagnosis?"
www.ncbi.nlm.nih.gov/pubmed/23312370


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