Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review
Pitfalls in Diagnosing Urinary Tract Infection in Children Below the Age of 2 : Suprapubic Aspiration Vs. Clean Catch Urine Sampling. / Breinbjerg, Anders; Mohamed, Libin; Yde Nielsen, Stine et al.
In: The Journal of Urology, Vol. 206, No. 6, 12.2021, p. 1482-1489.Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review
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TY - JOUR
T1 - Pitfalls in Diagnosing Urinary Tract Infection in Children Below the Age of 2
T2 - Suprapubic Aspiration Vs. Clean Catch Urine Sampling
AU - Breinbjerg, Anders
AU - Mohamed, Libin
AU - Yde Nielsen, Stine
AU - Rittig, Søren
AU - Tullus, Kjell
AU - Kamperis, Konstantinos
PY - 2021/12
Y1 - 2021/12
N2 - PURPOSE: Reliable urine samples are of eminent importance when diagnosing urinary tract infections (UTI) in children. Non-invasive procedures are convenient, but likely to be contaminated. This study aimed to compare the diagnostic accuracy of urine samples obtained by the midstream clean-catch method (CCU) with urine obtained by suprapubic aspiration (SPA), and evaluate the ability of urinary dipstick to predict true infection.MATERIALS AND METHODS: Retrospectively, data on children <2 years of age, seen at our centre on suspicion of UTI, who had a CCU and a SPA performed at the same day, where included. Any growth in SPA was considered significant whereas for CCU we tested two cut-off values of 104 and 105 CFU/ml, along with urinary dipstick results.RESULTS: 223 children were included. Using a cut-off of ≥104 CFU/ml, 16.6% (n=37) of the cohort would be misdiagnosed if relying only on CCU. Using ≥105 CFU/ml, the number was 24.6% (n=55). Evaluating leucocyte esterase (LE) on urinary dipstick, a large difference between using CCU (sensitivity 94.7%, specificity 14.4%) and SPA (sensitivity 78.9%, specificity 82.2%) became obvious.CONCLUSIONS: A large number of children will be misdiagnosed if relying on CCU specimens compared to SPA. Relying on a negative leucocyte esterase dipstick test to rule out a UTI is not sufficient in a child with high suspicion of such an infection. SPA is a safe procedure, and we thus recommend its use, to avoid delay of treatment and unnecessary invasive follow-up investigations.
AB - PURPOSE: Reliable urine samples are of eminent importance when diagnosing urinary tract infections (UTI) in children. Non-invasive procedures are convenient, but likely to be contaminated. This study aimed to compare the diagnostic accuracy of urine samples obtained by the midstream clean-catch method (CCU) with urine obtained by suprapubic aspiration (SPA), and evaluate the ability of urinary dipstick to predict true infection.MATERIALS AND METHODS: Retrospectively, data on children <2 years of age, seen at our centre on suspicion of UTI, who had a CCU and a SPA performed at the same day, where included. Any growth in SPA was considered significant whereas for CCU we tested two cut-off values of 104 and 105 CFU/ml, along with urinary dipstick results.RESULTS: 223 children were included. Using a cut-off of ≥104 CFU/ml, 16.6% (n=37) of the cohort would be misdiagnosed if relying only on CCU. Using ≥105 CFU/ml, the number was 24.6% (n=55). Evaluating leucocyte esterase (LE) on urinary dipstick, a large difference between using CCU (sensitivity 94.7%, specificity 14.4%) and SPA (sensitivity 78.9%, specificity 82.2%) became obvious.CONCLUSIONS: A large number of children will be misdiagnosed if relying on CCU specimens compared to SPA. Relying on a negative leucocyte esterase dipstick test to rule out a UTI is not sufficient in a child with high suspicion of such an infection. SPA is a safe procedure, and we thus recommend its use, to avoid delay of treatment and unnecessary invasive follow-up investigations.
U2 - 10.1097/JU.0000000000002117
DO - 10.1097/JU.0000000000002117
M3 - Journal article
C2 - 34288716
VL - 206
SP - 1482
EP - 1489
JO - Journal of Urology
JF - Journal of Urology
SN - 0022-5347
IS - 6
ER -