Presentation Authors: Chi-Shin Tseng, Shin-Mei Wong, Ming-Chieh Kuo, I-Ni Chiang, Kuo-How Huang, Chao-Yuan Huang, Yeong-Shiau Pu, Hong-Chiang Chang, Yu-Cheng Lu*, Taipei, Taiwan
Introduction: In the literature, the percentage of bacterial etiology in pediatric acute epididymitis is around 16-31%. However, more than 80% of patients received antibiotic treatment due to the uncertainty of urinalysis. This is an innovative study to compare C-reactive protein (CRP) and urinalysis in predicting acute bacterial epididymitis (ABE).
Methods: We retrospectively reviewed the medical records of pediatric patients ( < 18 years of age) with acute epididymitis from January 2009 to July 2018. The patient profiles, clinical symptoms, physical findings, laboratory data, and types of treatment were collected. The patients were sorted into ABE or ANBE (acute nonbacterial epididymitis) group according to positive or negative pathogen growth from urine culture. The primary endpoint was the percentage of patients with the ABE and the percentage of patients with antibiotic therapy. The secondary endpoint was to evaluate the diagnostic accuracy of CRP and urinalysis for ABE.
Results: A total of 200 patients with acute epididymitis were studied and antibiotics were administered to 159 (79.5%) patients. A urine culture was obtained for 120 patients, and 40 (33.3%) were positive for a bacterial source. The median CRP was significantly higher in ABE group (3.68 mg/dL, IQR (1.62-7.483)) than in ANBE group (0.4 mg/dL, IQR (0.065-1.825)). A positive urinalysis was found in 18 (45%) patients in ABE group which was higher than 16 (20%) patients in ANBE group. A multivariate analysis revealed that the risk factor of ABE was elevated CRP (odds ratio [OR] 23.1, p = 0.005) but not the positive urinalysis (OR 4.18, p = 0.069). The diagnostic accuracy measured by the area under the ROC curve of CRP was 0.797 which was higher than 0.701 of urinalysis.
Conclusions: The results demonstrated a huge discrepancy between the percentage of patients with ABE and patients who received antibiotic therapy. Practitioners should consider prescribing antibiotics only to those patients with ABE. To distinguish between ABE and ANBE, CRP was a more accurate tool than urinalysis for the diagnosis in pediatric populations.