September 2013 ORIGINAL ARTICLES

32. Hermos JA, Young MM, Fonda JR, Gagnon DR, Fiore LD, Lawler EV.

Risk of community-acquired pneumonia in veteran patients to whom

proton pump inhibitors were dispensed. Clin Infect Dis 2012;54:33-42.

33. Sarkar M, Hennessy S, Yang YX. Proton-pump inhibitor use and the risk

for community-acquired pneumonia. Ann Intern Med 2008;149:391-8.

34. Gau JT, Acharya U, Khan S, Heh V, Mody L, Kao TC. Pharmacotherapy

and the risk for community-acquired pneumonia. BMC Geriatr 2010;6:

45-53.

35. Dublin S,Walker RL, JacksonML, Nelson JC,Weiss NS, Jackson LA. Use

of proton pump inhibitors and H2 blockers and risk of pneumonia in

older adults: a population-based case-control study. Pharmacoepide-

miol Drug Saf 2010;19:792-802.

Association of CYP2C19 Polymorphisms and Lansoprazole-Asso

36. Sultan N, Nazareno J, Gregor J. Association between proton pump

inhibitors and respiratory infections: a systematic review and meta-

analysis of clinical trials. Can J Gastroenterol 2008;22:761-6.

37. Estborn L, Joelson S. Occurrence of community-acquired respiratory

tract infection in patients receiving esomeprazole: retrospective analysis

of adverse events in 31 clinical trials. Drug Saf 2008;31:627-36.

38. Moayyedi P, Leontiadis GI. The risks of PPI therapy. Nat Rev Gastroen-

terol Hepatol 2012;9:132-9.

39. Irvin CG, Kaminsky DA, Anthonisen NR, Castro M, Hanania NA,

Holbrook JT, et al. Clinical trial of low-dose theophylline and montelu-

kast in patients with poorly controlled asthma. Am J Respir Crit Care

Med 2007;175:235-42.

50 Years Ago in THE JOURNAL OF PEDIATRICS

Bacteriuria in Children with Acute Febrile IllnessesNorth AF. J Pediatr 1963;63:408-11

Knowing the prevalence of a particular disease is important. It helps us interpret diagnostic tests and guidetreatment. It is even more important when the disease can have long-term complications, such as renal scarring

after urinary tract infections (UTI).In this study, Dr North studied 82 children presenting to either an emergency department or an ambulatory

clinic with an acute febrile illness. A clean-catch or catheterized urine sample was obtained in all patients. UTI or“significant” bacteriuria was defined as a positive culture with >100 000 cfu/mL. There were 3 patients with a UTI,1 with obvious signs and symptoms of pyelonephritis signs and 2 with repeat negative cultures. Two other patientshad cultures with >10 000 cfu/mL in clean-catch samples and were considered negative. The author stated thatUTI was seldom the cause of acute febrile illness in children.

Although that last statement may cause concern nowadays, this study was possibly one of the first efforts to establishthe prevalence of UTI in children. The study population is not representative of today’s epidemiology, and microbi-ology methods may have changed; however, as shown in a systematic review by Shaikh et al,1 the prevalence of UTIremains unclear today, and may vary from 2.9 to 13.6 per 100 patients, depending on age and setting.

Another interesting aspect of this article is that even 5 decades ago, doctors were aware of the possibility of urine bagsample contamination. Bags are still used today in some circumstances for reasons of practicality.

All in all, this study raised an important issue of the frequency of UTIs in febrile children. Fifty years later, we stillhave doubts, but at least we know that we should keep looking for these infections.

Giordano P�erez-Gaxiola, MDEvidence-Based Medicine Department

Hospital Pedi�atrico de SinaloaCuliac�an, Mexico

http://dx.doi.org/10.1016/j.jpeds.2013.03.051

Reference

1. Shaikh N,Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008;27:302-8.

ciated Respiratory Adverse Effects in Children 691