Comparison of urine contamination rates using three different methods of collection: clean-catch, cotton wool pad and urine bag

Alam, Mahbubul; Coulter, J. B. S.; Pacheco, Juan Jose; Correia, Juliana Mendes; Ribeiro, M.G.B.; Coelho, Mônica Franco; Bunn, James

doi:10.1179/146532805x23326

Cited by 53 publications

(47 citation statements)

References 7 publications

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“…[89][90][91][92][93][94][95][96][97][98] Overdiagnosing UTI can lead to unnecessary investigations and treatment, which entail risks of complications and psychological stress to the child and family. Discriminating between contamination with faecal organisms and potential UTI pathogens in the laboratory is difficult as the most common faecal organism and the most common pathogen causing UTI is E. coli, and high colony counts may be found in children without UTI.…”

Section: Contaminationmentioning

confidence: 99%

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

Hay

Birnie²,

Busby³

et al. 2016

Health Technol Assess

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BackgroundIt is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment.ObjectivesTo develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness.DesignMulticentre, prospective diagnostic cohort study.Setting and participantsChildren < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms.MethodsOne hundred and seven clinical characteristics (index tests) were recorded from the child’s past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood (‘clinical diagnosis’) and urine sampling and treatment intentions (‘clinical judgement’) were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 105colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the ‘clinician diagnosis’ AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with ‘clinical judgement’.ResultsA total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, ‘clinical diagnosis’ correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were < 2 years old and 1.3% met the UTI definition. ‘Clinical diagnosis’ correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut.ConclusionsClinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Contaminationmentioning

confidence: 99%

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

Hay

Birnie²,

Busby³

et al. 2016

Health Technol Assess

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“…Además, es la técnica menos agresiva para los pacientes. 10 . Otro estudio, que comparó los diferentes métodos de recogida de muestra de orina en niños menores de dos años, asocia la recogida mediante acecho con un índice de contaminación del 26%, significativamente mayor que aquellas recogidas por sondaje (12%) o punción suprapúbica (1%).…”

Section: Discussionunclassified

Recogida de orina en el lactante febril para el diagnóstico de la infección urinaria en Urgencias

Samanes

Lafuente

Gracia

et al. 2015

Rev Pediatr Aten Primaria

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Collection of urine in febrile infants for diagnosis of urinary tract infection in the Emergencies' roomIntroducción: la infección del tracto urinario (ITU) es una enfermedad frecuente en niños. Resulta fundamental una adecuada recogida de orina para evitar falsos positivos, minimizando procedimientos invasivos. La recogida de orina al acecho es una técnica incruenta, con baja tasa de contaminación, por lo que se estableció como método de elección al actualizar nuestro protocolo clínico.

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“…Urine microbial contamination rates have been reported to be significantly lower with the clean catch method and similarly higher for pads and urine collection bags (Alam et al, 2005). The National Institute for Clinical Excellence (2009) suggests that urine collection pads are the next best option, if the clean catch is not suitable.…”

Section: Discussionmentioning

confidence: 99%

“…The disadvantage of the pads is the difficulty of aspirating urine, especially when only a small amount has been voided (Alam et al, 2005), and the difficulty in analyzing for a large number of analytes (Barr et al, 2005a). Clean catch methods are often time-consuming and impractical.…”

Section: Discussionmentioning

confidence: 99%

“…The technique depends on inducing a voiding reflex by applying gently repetitive suprapubic pressure (Morris et al, 2007). Given the human resource requirements to collect the urine from the infant, this method would not be practicable for a large-scale study; however, in a study of 191 children with a median age of 2 months, urine was collected successfully by clean catch in 88%, and by urine bags and pads in 96% of the infants (Alam et al, 2005). These three methods were used consecutively with the parents trained to collect the clean catch sample (parents had a 30 ml urine container ready to collect urine from the infant who sat on their lap without a diaper) and study nurses assisted with collecting urine from the pads and bags (Alam et al, 2005).…”

Section: Clean Catchmentioning

confidence: 99%

See 1 more Smart Citation

Urine-sampling methods for environmental chemicals in infants and young children

Lee

Arbuckle

2009

J Expo Sci Environ Epidemiol

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This review paper examines and evaluates urine-sampling methodologies in infants and young children, to determine which methods are suitable for use in large biomonitoring surveys or studies of environmental chemicals in children younger than 6 years. Methods for non-toilet-trained children include the use of urine bags, collection pads (e.g., cotton or gauze inserts), disposable diapers, cotton diapers, and the clean catch method. In toilet-trained children, collection methods include use of a commode insert pan as well as specimen collection cups. The advantages and disadvantages of these various methods need to be evaluated with respect to the target population, timing and frequency of collection, minimum sample volume required, method of urine extraction, potential for contamination of the sample, stability of the analyte of interest, and burden on participants and research team. Collection methods must not introduce contamination or affect the integrity of the sample, should be logistically practical, and should minimize discomfort experienced by the child. Although collection of urine samples from children who are not toilet-trained is more challenging than collection from older toilet-trained children, the vulnerability of younger children to the exposure to and health effects of environmental chemicals makes finding suitable methods a priority.

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Comparison of urine contamination rates using three different methods of collection: clean-catch, cotton wool pad and urine bag

Cited by 53 publications

References 7 publications

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

Recogida de orina en el lactante febril para el diagnóstico de la infección urinaria en Urgencias

Urine-sampling methods for environmental chemicals in infants and young children

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