Pitfalls in Diagnosing Urinary Tract Infection in Children Below the Age of 2: Suprapubic Aspiration Vs. Clean Catch Urine Sampling

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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.

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@article{e1ddd4ebd72e417d81f13ca75fd04ede,
title = "Pitfalls in Diagnosing Urinary Tract Infection in Children Below the Age of 2: Suprapubic Aspiration Vs. Clean Catch Urine Sampling",
abstract = "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.",
author = "Anders Breinbjerg and Libin Mohamed and {Yde Nielsen}, Stine and S{\o}ren Rittig and Kjell Tullus and Konstantinos Kamperis",
year = "2021",
month = dec,
doi = "10.1097/JU.0000000000002117",
language = "English",
volume = "206",
pages = "1482--1489",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "6",

}

RIS

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 -