We appreciate the thoughtful comments by Dr Tsujimoto and colleagues, who are concerned that our sensitivity estimates may mislead practitioners to assume that a negative urinalysis (UA) rules out bacteremic UTI (or UTI in general). The intent of our study was not to assess whether a UA rules in or rules out bacteremic UTI, but rather to analyze the UA in a population of infants with definitive infection. Although Tsujimoto et al are concerned that the UA sensitivity is overestimated in our study, we are similarly concerned that all previous studies have underestimated the UA sensitivity by using the urine culture as a gold standard when in fact many “positive” urine cultures reflect contamination or asymptomatic bacteruria. Whether bacteremic UTI represents UTI in general or represents a more severe form of UTI is debatable. Most investigations comparing infants with bacteremic versus nonbacteremic UTI have demonstrated few if any clinical differences...

You do not currently have access to this content.