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Choice of urine collection methods for the diagnosis of urinary tract infection in young, febrile infants.
Arch Pediatr Adolesc Med. 2005 Oct; 159(10):915-22.AP

Abstract

BACKGROUND

The optimal method of urine collection in febrile infants is debatable; catheterization, considered more accurate, is technically difficult and invasive.

OBJECTIVES

To determine predictors of urethral catheterization in febrile infants and to compare bag and catheterized urine test performance characteristics.

DESIGN

Prospective analysis of infants enrolled in the Pediatric Research in Office Settings' Febrile Infant Study.

SETTING

A total of 219 practices from within the Pediatric Research in Office Settings' network, including 44 states, the District of Columbia, and Puerto Rico.

PATIENTS

A total of 3066 infants aged 0 to 3 months with temperatures of 38 degrees C or higher.

MAIN OUTCOME MEASURES

We calculated adjusted odds ratios for predictors of catheterization. Diagnostic test characteristics were compared between bag and catheterization. Urinary tract infection was defined as pure growth of 100 000 CFU/mL or more (bag) and 20 000 CFU/mL or more (catheterization).

RESULTS

Seventy percent of urine samples were obtained by catheterization. Predictors of catheterization included female sex, practitioner older than 40 years, Medicaid, Hispanic ethnicity, nighttime evaluation, and severe dehydration. For leukocyte esterase levels, bag specimens demonstrated no difference in sensitivity but somewhat lower specificity (84% [bag] vs 94% [catheterization], P<.001) and a lower area under the receiver operating characteristic curve for white blood cells (0.71 [bag] vs 0.86 [catheterization], P = .01). Infection rates were similar in bag and catheterized specimens (8.5% vs 10.8%). Ambiguous cultures were more common in bag specimens (7.4% vs 2.7%, P<.001), but 21 catheterized specimens are needed to avoid each ambiguous bag result.

CONCLUSIONS

Most practitioners obtain urine from febrile infants via catheterization, but choice of method is not related to the risk of urinary tract infection. Although both urine cultures and urinalyses are more accurate in catheterized specimens, the magnitude of difference is small but should be factored into clinical decision making.

Authors+Show Affiliations

Departments of Pediatrics and Epidemiology, University of California-San Francisco, San Francisco, CA 94143, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16203935

Citation

Schroeder, Alan R., et al. "Choice of Urine Collection Methods for the Diagnosis of Urinary Tract Infection in Young, Febrile Infants." Archives of Pediatrics & Adolescent Medicine, vol. 159, no. 10, 2005, pp. 915-22.
Schroeder AR, Newman TB, Wasserman RC, et al. Choice of urine collection methods for the diagnosis of urinary tract infection in young, febrile infants. Arch Pediatr Adolesc Med. 2005;159(10):915-22.
Schroeder, A. R., Newman, T. B., Wasserman, R. C., Finch, S. A., & Pantell, R. H. (2005). Choice of urine collection methods for the diagnosis of urinary tract infection in young, febrile infants. Archives of Pediatrics & Adolescent Medicine, 159(10), 915-22.
Schroeder AR, et al. Choice of Urine Collection Methods for the Diagnosis of Urinary Tract Infection in Young, Febrile Infants. Arch Pediatr Adolesc Med. 2005;159(10):915-22. PubMed PMID: 16203935.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Choice of urine collection methods for the diagnosis of urinary tract infection in young, febrile infants. AU - Schroeder,Alan R, AU - Newman,Thomas B, AU - Wasserman,Richard C, AU - Finch,Stacia A, AU - Pantell,Robert H, PY - 2005/10/6/pubmed PY - 2005/11/9/medline PY - 2005/10/6/entrez SP - 915 EP - 22 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 159 IS - 10 N2 - BACKGROUND: The optimal method of urine collection in febrile infants is debatable; catheterization, considered more accurate, is technically difficult and invasive. OBJECTIVES: To determine predictors of urethral catheterization in febrile infants and to compare bag and catheterized urine test performance characteristics. DESIGN: Prospective analysis of infants enrolled in the Pediatric Research in Office Settings' Febrile Infant Study. SETTING: A total of 219 practices from within the Pediatric Research in Office Settings' network, including 44 states, the District of Columbia, and Puerto Rico. PATIENTS: A total of 3066 infants aged 0 to 3 months with temperatures of 38 degrees C or higher. MAIN OUTCOME MEASURES: We calculated adjusted odds ratios for predictors of catheterization. Diagnostic test characteristics were compared between bag and catheterization. Urinary tract infection was defined as pure growth of 100 000 CFU/mL or more (bag) and 20 000 CFU/mL or more (catheterization). RESULTS: Seventy percent of urine samples were obtained by catheterization. Predictors of catheterization included female sex, practitioner older than 40 years, Medicaid, Hispanic ethnicity, nighttime evaluation, and severe dehydration. For leukocyte esterase levels, bag specimens demonstrated no difference in sensitivity but somewhat lower specificity (84% [bag] vs 94% [catheterization], P<.001) and a lower area under the receiver operating characteristic curve for white blood cells (0.71 [bag] vs 0.86 [catheterization], P = .01). Infection rates were similar in bag and catheterized specimens (8.5% vs 10.8%). Ambiguous cultures were more common in bag specimens (7.4% vs 2.7%, P<.001), but 21 catheterized specimens are needed to avoid each ambiguous bag result. CONCLUSIONS: Most practitioners obtain urine from febrile infants via catheterization, but choice of method is not related to the risk of urinary tract infection. Although both urine cultures and urinalyses are more accurate in catheterized specimens, the magnitude of difference is small but should be factored into clinical decision making. SN - 1072-4710 UR - https://www.unboundmedicine.com/medline/citation/16203935/Choice_of_urine_collection_methods_for_the_diagnosis_of_urinary_tract_infection_in_young_febrile_infants_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/archpedi.159.10.915 DB - PRIME DP - Unbound Medicine ER -