EFFECT OF URINE LATEX AGGLUTINATION TESTS ON THE TREATMENT OF CHILDREN AT RISK FOR INVASIVE BACTERIAL-INFECTION

Background. Identifying febrile children with invasive bacterial infec tion is difficult in the absence of telltale physical findings. Urine latex agglutination (ULA) tests have been used for rapid, on-site iden tification of such children. Objectives. To study the performance of U LA tests in identifying children with Haemophilus influenzae, Streptoc occus pneumoniae, and group B streptococcus infection and to examine h ow the results of ULA tests affect patient treatment.Design. Retrospec tive review. Setting. Urban children's hospital. Patients. All emergen cy department and hospital patients tested by ULA in 1990, excluding p atients in the neonatal units. Results. Of 1629 patients, 36 had posit ive tests (20 H influenzae, 5 S pneumoniae, and 11 group B streptococc us). Thirteen of these were false positive based on culture results. A lthough ULA tests demonstrated excellent specificity, their sensitivit y was poor. Positive predictive values for bacteremia ranged from 0.34 6 to 0.600, and negative predictive values ranged from 0.972 to 0.997. The decision to treat with antibiotics was made before ULA test resul ts were available in 19 (53%) of the 36 patients with positive test re sults. Of 1593 patients with negative test results, 1211 (76%) were ad mitted to the hospital, and approximately 81% were empirically treated with parenteral antibiotics. Conclusions. In clinical practice, treat ment and disposition decisions are frequently made without regard to U LA test results.