Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: An observational cohort study

Tosif, Shidan; Baker, Alice; Oakley, Edward; Donath, Susan; Babl, Franz E

doi:10.1111/j.1440-1754.2012.02449.x

Cited by 123 publications

(132 citation statements)

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“…Contamination rates have been shown to vary from 0% in clean-catch urine of 23 samples to 48% of bag urines. 98 In a retrospective observational cohort study, contamination in clean catch, catheter specimen of urine and bag was 1%, 12% and 26%. 98 Definitions of contamination vary from single organism growth < 10 5 OR ≥ 2 organisms to ≥ 2 organisms present at > 10 5 CFU/ml of urine.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…98 In a retrospective observational cohort study, contamination in clean catch, catheter specimen of urine and bag was 1%, 12% and 26%. 98 Definitions of contamination vary from single organism growth < 10 5 OR ≥ 2 organisms to ≥ 2 organisms present at > 10 5 CFU/ml of urine. In a US study, no institutional factors, such as access to refrigeration, were found to associate with either low or high contamination rates.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…[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%

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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: Comparison With Existing Literaturementioning

confidence: 99%

Section: Comparison With Existing Literaturementioning

confidence: 99%

Section: Contaminationmentioning

confidence: 99%

See 1 more Smart Citation

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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“…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%). Relacionan el elevado porcentaje de contaminación en la primera técnica citada con la falta de estándares de recogida, y recomiendan nuevos estudios, dada la alta variabilidad de tasas de contaminación en la bibliografía 11 . En nuestra experiencia, las cifras de contaminación en las muestras recogidas mediante el acecho y aquellas por sondaje vesical fueron similares, por lo que podemos considerar el acecho como una técni-ca válida para la obtención de muestras de orina.…”

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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“…Two recent studies, carried out in a hospital setting, evaluated the preferred methods of urine collection for UTI diagnosis in children in two different pediatric departments, one in Turkey [ 13 ], which reported a population aged 0-16 years, and the other in Australia [ 14 ], which looked at a population younger than 2 years of age. In the Turkish study, considering only the subjects aged 2 years and under (532), the sterile bag was the most frequently used method and was used in 90 % of cases, followed by clean catch in 7 %.…”

Section: Urine Collectionmentioning

confidence: 99%

Urinary Tract Infections: An Overview of Urine Collection, Imaging, and Prevention

2014

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IntroductionDiagnosis of UTI is common in every day pediatric clinical practice. During the fi rst 6 years of life, the annual incidence is around 1.7/1,000 for boys and 3.1/1,000 for girls, while approximately 6-7 % of girls and 2.5 % of boys will develop a UTI during this period [ 1 ]. In the fi rst 2 years of life, fUTIs prevail in both sexes, and then the rate of non febrile UTI increases, particularly in girls [ 1 , 2 ]. The rate of bacteriuria is more diffi cult to ascertain. Screening studies have demonstrated a prevalence of 1.9 % in schoolgirls and 0.2 % in schoolboys aged 5-18 years [ 3 , 4 ]. During the follow-up period of the Italian Renal Infection Study 2 [ 5 ], a randomized controlled study (RCT) carried out in order to determine the effectiveness of 12-month antimicrobial prophylaxis in preventing UTI recurrences, 2,052 urinalyses and urine cultures were performed in children of both sexes, aged between 2 and 36 months. In this cohort of children, considered to be at risk because of a previous fUTIs, with or without associated vesicoureteral refl ux, a 1.5 % rate of asymptomatic bacteriuria was detected (personal series). The management of children with a UTI has always been a matter of debate as far as diagnosis, imaging, and antibiotic prophylaxis are concerned. While some recent trials have succeeded in leading to agreement on certain issues, other important points of contention remain. Here we focus on several of the most controversial. Urine CollectionWhen a UTI is suspected, a sterile urine specimen should be collected for urinalysis and urine culture before antibiotic therapy is initiated.

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Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: An observational cohort study

Abstract: Contamination rates in CCU are much higher than in CSU and SPA samples. Ideally, SPA should be used for microbiological assessment of urine in young children. Collection procedures need to be optimised if CCU is used.

Cited by 123 publications

References 26 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

Urinary Tract Infections: An Overview of Urine Collection, Imaging, and Prevention

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