Diagnosing urinary tract infection in children: time to ditch the pad?

Harkensee, Christian; Clennett, Julie; Wilkinson, Sarah; Tse, Yincent

doi:10.1136/archdischild-2020-320290

Cited by 3 publications

(5 citation statements)

References 7 publications

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“…The growth of pathogens in an uncontaminated urine specimen is the cornerstone for UTI diagnosis [ 16 ]. For this purpose, bladder catheterization and suprapubic puncture are considered the gold standard to collect urine both in infants and in not-toiled trained children [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Emergency care providers would rather rarely employ bladder catheterization or suprapubic puncture likely because these are personnel and time intensive, and a possible source of pain for children and distress for caregivers [ 17 , 18 ]. New strategies, such as the collection of urine from nappy pad or bladder stimulation technique to obtain midstream urine, might be an interesting and promising alternative [ 16 , 19 ]. We suggest that the emergency units review their practice by considering and validating new urine collection methods for culture that may be effective and safe also in centers with limited staffing and resources, and in small centers.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

et al. 2022

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Urinary tract infections (UTIs) are among the most frequent bacterial diseases in infants and children. Physician adherence to recommendations is notoriously often poor, but no data are available on UTIs management in the emergency setting. In this multicenter national study, we investigated the policies regarding UTIs management in children aged 2 months to 3 years in Italian emergency units. Between April and June 2021, directors of the emergency units were invited to answer an online survey on the following items: diagnostic approach to children with fever without an apparent source, therapeutic approach to UTIs, the use of kidney and urinary tract ultrasound, and the criteria for hospitalization. A total of 121 (89%) out of 139 of invited units participated in the study. Overall, units manage children with a suspected or confirmed UTI according to available recommendations for most of the items. However, in almost 80% (n = 94) of units, a sterile perineal bag is used to collect urine for culture. When urine is collected by cathether, heterogeneity exists on the threshold of bacterial load considered for UTI diagnosis. Conclusions: Available recommendations on UTIs in children are followed by Italian emergency units for most of the items. However, the methods to collect urine specimens for culture, one of the crucial steps of the diagnostic work-up, often do not align with current recommendations and CFU thresholds considered for diagnosis largely vary among centers. Efforts should be addressed to validate and implement new child and family friendly urine collection techniques. What is Known:• Several guidelines are published on the management of children with suspected or confirmed urinary tract infection.• No data are available on the management of pediatric urinary tract infections in the emergency setting. What is New:• Almost 80% of the Italian emergency units employ a sterile perineal bag to collect urine for culture.• Diagnostic CFU thresholds largely vary among centers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

et al. 2022

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“…Pads appear to be a convenient urine sampling method, preferred by parents and staff, but outside clinical trial settings they have high contamination rates 13 14. Replacing the pad for clean catch is challenging in busy hospital settings and unrealistic in primary care despite ultimately being more cost and time effective for the health economy 13 15. Reassuringly, we did not find non -E. coli bacteria over-represented in pad collection samples compared with clean catch.…”

Section: Discussionmentioning

confidence: 59%

“…In the multi-centre DUTY study involving 225 GP surgeries and 7163 children <5 years old in South England and Wales, 50% of urine samples collected were pad samples and 41% were collected in the child’s home 2. Pads appear to be a convenient urine sampling method, preferred by parents and staff, but outside clinical trial settings they have high contamination rates 13 14. Replacing the pad for clean catch is challenging in busy hospital settings and unrealistic in primary care despite ultimately being more cost and time effective for the health economy 13 15.…”

Section: Discussionmentioning

confidence: 99%

Low yield from imaging after non-E. coliurine tract infections in children treated in primary care and emergency department

et al. 2023

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BackgroundImaging is recommended for selected children following urinary tract infections (UTIs) to look for actionable structural abnormalities. Non-E. coliis considered high risk in many national guidelines, but evidence is mainly drawn from small cohorts from tertiary centres.ObjectiveTo ascertain imaging yield from infants and children <12 years diagnosed with their first confirmed UTI (pure single growth >1 00 000 cfu) in primary care or an emergency department without admission stratified by bacteria type.Design, setting, patientsData were collected from an administrative database of a UK citywide direct access UTI service between 2000 and 2021. Imaging policy mandated renal tract ultrasound and Technetium-99m dimercaptosuccinic acid scans in all children, plus micturating cystourethrogram in infants <12 months.Results7730 children (79% girls, 16% aged <1 year, 55% 1–4 years) underwent imaging after first UTI diagnosed by primary care (81%) or emergency department without admission (13%).E. coliUTI yielded abnormal kidney imaging in 8.9% (566/6384).Enterococcusand KPP (Klebsiella,Proteus,Pseudomonas) yielded 5.6% (42/749) and 5.0% (24/483) with relative risks 0.63 (95% CI 0.47 to 0.86) and 0.56 (0.38 to 0.83)), respectively. No difference was found when stratified by age banding or imaging modality.ConclusionIn this largest published group of infants and children diagnosed in primary and emergency care not requiring admission, non-E. coliUTI was not associated with a higher yield from renal tract imaging.

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“…Urinary tract infection (UTI) represents one of the most frequent bacterial infections in children [1]. Escherichia coli (E. coli) is the most often incriminated etiological agent, accounting for 80-90% of UTIs in children [2].…”

Section: Introductionmentioning

confidence: 99%

Vitamin D Status and Its Role in First-Time and Recurrent Urinary Tract Infections in Children: A Case-Control Study

Muntean

Săsăran

2021

Children

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Vitamin D has emerged as a key factor in innate immunity. Its involvement in the pathogenesis of urinary tract infections (UTIs) has gained a lot of attention recently. The objective of this study is to investigate the association between serum 25-hydroxyvitamin D (25(OH)D) levels and first-time or recurrent UTIs in children. A prospective, case-control study was conducted on 101 pediatric patients, who were divided into two groups: 59 patients with UTIs and 42 age-matched healthy controls. Serum 25(OH)D was determined in each child and expressed in ng/mL. Vitamin D presented significantly lower values in study group subjects than in healthy controls (p < 0.01). Moreover, a significantly higher prevalence of vitamin D insufficiency and deficiency was found in children with UTIs (p < 0.01). Patients with recurrent UTIs presented significantly lower levels of vitamin D than those with first-time UTIs (p = 0.04). Urinary tract abnormalities did not seem to exercise an additional effect upon vitamin D levels within the study group. In conclusion, first-time and recurrent UTIs are associated with lower vitamin D levels. Further studies are necessary to validate our findings, as well as future longitudinal research regarding efficacy of vitamin D supplementation in children with UTIs.

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Diagnosing urinary tract infection in children: time to ditch the pad?

Cited by 3 publications

References 7 publications

Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

Diagnosis and management of urinary tract infections in children aged 2 months to 3 years in the Italian emergency units: the ItaUTI study

Low yield from imaging after non-E. coliurine tract infections in children treated in primary care and emergency department

Vitamin D Status and Its Role in First-Time and Recurrent Urinary Tract Infections in Children: A Case-Control Study

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