Abstract
BackgroundUrinary tract infections (UTIs) are common in young pre-continent children, but collecting urine samples is challenging. Collection methods all have limitations and international guidelines have conflicting recommendations. Choice of method must balance time, resources, invasiveness, reliability, and contamination. Evidence from primary care clinicians is limited regarding barriers and enablers to sample collection, and what factors inform the choice and use of different sample collection methods.AimTo understand the barriers and enablers to collecting urine samples from young pre-continent children in primary care.Design & settingAn exploratory qualitative study performed in primary care in Australia.MethodSemi-structured interviews explored the topic of collecting a urine sample from a child aged 6 months who presented with a fever. The interviews were undertaken with 21 GPs and four practice nurses (PNs) until data saturation was reached. Interviews were audiorecorded, transcribed verbatim, coded, and underwent content and thematic analysis.ResultsFive main themes emerged including: the clinician’s knowledge and expertise; patient characteristics; parent or carer’s understanding and motivation; the collection process itself; and likely outcome of the chosen method. Non-invasive methods were strongly favoured; although, clean catch was considered time-consuming and urine bags were known to be often contaminated. Invasive methods (for example, catheterisation or suprapubic aspiration [SPA]) were rarely performed outside of remote settings. Key barriers included time and space constraints in clinics, and key enablers included parental motivation, education handouts, and voiding stimulation methods.ConclusionThis study has identified key barriers and enablers to inform education, policy, and future research for urine sample collection from pre-continent children in primary care. Guideline recommendations must consider the primary care context to ensure they are relevant and suited to real-world practice.
Highlights
Urinary tract infections (UTIs) are common in early childhood, affecting 2%–6% of febrile young children in UK primary care.[1,2] If untreated, UTI can cause significant complications, including sepsis, meningitis, and renal scarring
Author Keywords: urine specimen collection, infant, urinary tract infections, paediatrics, general practice, primary health care. How this fits in Collecting a urine sample to diagnose or exclude UTI in a young child can be challenging, and existing collection methods all have limitations
This qualitative study found that non-invasive collection methods were strongly preferred in primary care, clinicians thought that clean catch could be time-c onsuming and urine bag samples were often contaminated
Summary
UTIs are common in early childhood, affecting 2%–6% of febrile young children in UK primary care.[1,2] If untreated, UTI can cause significant complications, including sepsis, meningitis, and renal scarring. UTI may not be considered or evaluated on initial presentation, and so the diagnosis is often delayed or missed in primary care.[3,4] UK guidelines recommend that any young child with signs and symptoms that could suggest UTI, or unexplained fever, should have a urine sample tested.[5]. Collecting a urine sample from a young pre-continent child is challenging, and limitations exist with all current urine collection methods. These include non-invasive (for example, urine bags, pads, or clean catch) and invasive (for example, catheter or SPA) methods. Evidence from primary care clinicians is limited regarding barriers and enablers to sample collection, and what factors inform the choice and use of different sample collection methods
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