Abstract
ObjectiveMidstream clean-catch urine is an accepted method to diagnose urinary tract infection but is impracticable in infants before potty training. We tested the bladder stimulation technique to obtain a clean-catch urine sample in infants.Materials and methodsWe included 142 infants under walking age who required a urine sample in a cross- sectional study carried out during a 3-months period, from September to November 2014, in the emergency department of the University Children’s Hospital of Nice (France). A technique based on bladder stimulation and lumbar stimulation maneuvers, with at least two attempts, was tested by four trained physicians. The success rate and time to obtain urine sample within 3 minutes were evaluated. Discomfort (EVENDOL score ≥4/15) was measured. We estimated the risk factors in the failure of the technique. Chi-square test or Fisher’s exact test were used to compare frequencies. T-test and Wilcoxon test were used to compare quantitative data according to the normality of the distribution. Risk factors for failure of the technique were evaluated using a multivariate logistic regression model.ResultsWe obtained midstream clean-catch urine in 55.6% of infants with a median time of 52.0 s (10.0; 110.0). The success rate decreased with age from 88.9% (newborn) to 28.6% (>1 y) (p = 0.0001) and with weight, from 85.7% (<4kg) to 28.6% (>10kg) (p = 0.0004). The success rate was 60.8% for infants without discomfort (p<0.0001). Heavy weight and discomfort were associated with failure, with adjusted ORs of 1.47 [1.04–2.31] and 6.65 [2.85–15.54], respectively.ConclusionBladder stimulation seems to be efficient in obtaining midstream urine with a moderate success rate in our study sample. This could be an alternative technique for infants before potty training but further randomized multicenter studies are needed to validate this procedure.
Highlights
Urinary tract infection (UTI) is common in children [1,2,3,4]
The success rate decreased with age from 88.9% to 28.6% (>1 y) (p = 0.0001) and with weight, from 85.7% (10kg) (p = 0.0004)
Heavy weight and discomfort were associated with failure, with adjusted odds ratio (OR) of 1.47 [1.04–2.31] and 6.65 [2.85– 15.54], respectively
Summary
Urinary tract infection (UTI) is common in children [1,2,3,4]. Overall, 3–5% of young, febrile children have a UTI, including 5–7% of those “without a source of fever”. According to the American Academy of Pediatrics (AAP) [17,18], midstream clean-catch urine (CCU) is an accepted method to diagnose UTI. This method is impractical in infants before potty training. Urine samples are collected using sterile bags This is an easier technique, albeit time consuming, with 63% specificity [19,20], with the strong inconvenience of a high rate of contamination: from 40% to 62.8% according to published studies [21,22]. Other valuable but invasive techniques are suprapubic aspiration (SPA) and bladder catheterization These reduce the risk of urethral or skin contamination [23] but are invasive and painful procedures [24]. The 2011 AAP guidelines recommend that perineal bags should be used in children who do not appear to be unwell and have a low likelihood of UTI, as a screening step to decide whether to perform bladder catheterization or SPA (recommended to obtain a sample for urine culture in children with a positive urinalysis from a perineal bag)
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