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Abstract
Urinary tract infection is a commonly occurring paediatric infection associated with significant morbidity. Diagnosis is challenging as symptoms are non-specific and definitive diagnosis requires an uncontaminated urine sample to be obtained. Common techniques for sampling in non-toilet-trained children include clean catch, bag, pad, in-out catheterisation and suprapubic aspiration. The pros and cons of each method are examined in detail in this review. They differ significantly in frequency of use, contamination rates and acceptability to parents and clinicians. National guidance of which to use differs significantly internationally. No method is clearly superior. For non-invasive testing, clean catch sampling has a lower likelihood of contamination and can be made more efficient through stimulation of voiding in younger children. In invasive testing, suprapubic aspiration gives a lower likelihood of contamination, a high success rate and a low complication rate, but is considered painful and is not preferred by parents. Urine dipstick testing is validated for ruling in or out UTI provided that leucocyte esterase (LE) and nitrite testing are used in combination.
Highlights
Urinary tract infection (UTI) is a common bacterial infection and, as such, a common presentation to paediatric health services. 5.9% of children presenting acutely to UK General Practitioners will have a UTI, rising to 7.3% if the population is restricted to those < 3 years old [1] and 7% of those < 2 years with urinary symptoms [2].There are several common pathogens, with > 70% of cases due to E. coli, with c.10% involving other coliforms and c. 5% Proteus species [3–5]
We explore the relative merits of different methods of obtaining urine samples from non-toilet-trained children as well as reviewing the use of dipstick testing and microscopy in this patient group
The American Academy of Paediatrics (AAP) guidance [12] recommends that for diagnosis of UTI if antibiotics are to be given, the “specimen needs to be obtained through catheterization or suprapubic aspiration (SPA), because the diagnosis of UTI cannot be established reliably through culture of urine collected in a bag.”
Summary
Urinary tract infection (UTI) is a common bacterial infection and, as such, a common presentation to paediatric health services. 5.9% of children presenting acutely to UK General Practitioners (family doctors) will have a UTI, rising to 7.3% if the population is restricted to those < 3 years old [1] and 7% of those < 2 years with urinary symptoms [2]. There is a reduction in incidence of UTI with advancing age, which is of significance given the higher prevalence of UTI in non-toilet-trained children. Given the high prevalence of UTI, diagnostic difficulty and associated severe morbidity with delayed treatment, it is important to use the optimal approach to obtain urine samples to confirm or exclude this important diagnosis. We explore the relative merits of different methods of obtaining urine samples from non-toilet-trained children as well as reviewing the use of dipstick testing and microscopy in this patient group. We review the benefits and disadvantages of each method of urine collection
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