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Lindén M, Rosenblad T, Rosenborg K, Hansson S, Brandström P. Infant urinary tract infection in Sweden - A national study of current diagnostic procedures, imaging and treatment. Pediatr Nephrol 2024:10.1007/s00467-024-06415-4. [PMID: 39008116 DOI: 10.1007/s00467-024-06415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Urinary tract infection (UTI) in infants is a common, potentially life-threatening bacterial infection, and must be managed carefully through the entire chain of care from diagnosis, choice of treatment, follow-up and risk stratification of future complications. This Swedish nationwide study of infant UTI was conducted to evaluate the current management of infant UTI, yield of investigations and the Swedish UTI guidelines' ability to detect abnormalities of importance in the urinary tract. METHODS Infants < 1 year with a first episode of UTI were included in a prospective multicenter study. Treatment and follow-up were provided by local pediatricians. Clinical and laboratory findings and imaging results were reported to the coordinating center. The current management and results were compared with a previous Swedish study. RESULTS One thousand three hundred six infants were included. Urine sampling was performed with clean catch technique in 93% of patients. Initial oral antibiotic treatment was used in 63%, predominantly third generation cephalosporines. Permanent kidney abnormalities were found in 10% and dilating vesicoureteral reflux (VUR) in 8%. Higher rates of male gender, non-E. coli infection and ultrasound dilatation were seen in infants < 1 month. UTI recurrences were reported in 18%. CONCLUSIONS Infant UTI is still generating a considerable amount of follow-up examinations. There is a significant shift towards clean catch as the main urine sampling method. Voiding cystourethrography is performed less frequently reducing the findings of low grade VUR. The incidence of renal scarring is comparable with earlier studies which suggests that the Swedish guidelines are able to identify individuals with risk for long-term complications.
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Affiliation(s)
- Magnus Lindén
- Department of Pediatrics, Halland Hospital, Halmstad, Sweden.
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Therese Rosenblad
- Department of Pediatrics, Lund Children's Hospital, Lund, Sweden
- Division of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Karin Rosenborg
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Sverker Hansson
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Pediatric Uro-Nephrology Center, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Per Brandström
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Pediatric Uro-Nephrology Center, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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Korkmaz N, Narter FK, Mutlu B, Şahin K, Özgörü H. Effects of the bladder stimulation technique on urine sample collection in newborns: A randomized controlled study. Int J Nurs Pract 2024:e13255. [PMID: 38622105 DOI: 10.1111/ijn.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 02/17/2024] [Accepted: 03/10/2024] [Indexed: 04/17/2024]
Abstract
AIM The aim of this study is to investigate the effectiveness of the bladder stimulation technique (BST) to collect urine samples from newborns and its effects on physiological parameters and comfort of the newborn. DESIGN This was a randomized controlled trial conducted in a NICU. A total of 64 newborns were divided into 2 groups: 32 newborns in the experimental group and 32 newborns in the control group. METHODS Newborns in the experimental group (EG) were subjected to the BST, and in the control group (CG), urine collection was via sterile urine bags, which is routine practice. Procedural success was defined as the collection of urine samples within 3 min of beginning the stimulation technique in the experimental group and of placing the sterile urine bag in the control group. RESULTS The success rate of the procedure in 3 min was 62.5% in the EG and 28% in the CG (P = 0.006, absolute difference: 35%, 95% confidence interval 27% to 42%, NNT: 3). According to the comparison of the overall mean COMFORTneo scale and pain and distress subscale scores at the 1- and 3-min marks, there was a significant difference between the EG and CG (p < 0.05). The mean scores in the EG were higher than those in the CG. The mean oxygen-saturation was significantly lower in the EG than in the CG (p < 0.05), and the increase in heart rate was significantly higher in the EG (p = 0.018). CONCLUSIONS BST is a more successful method within 3 min for collecting urine samples from newborns compared to sterile urine bags. However, the newborns' comfort levels minimally decreased at 3 min, and they had moderate pain and distress, while the BST was being implemented. This increase in physiologic parameters was statistically significant but not clinically significant.
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Affiliation(s)
- Nihan Korkmaz
- Florence Nightingale Faculty of Nursing, Department of Pediatric Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Fatma Kaya Narter
- Kartal Dr Lutfi Kirdar Training and Research Hospital, Department of Neonatology, University of Health Sciences, Istanbul, Turkey
| | - Birsen Mutlu
- Florence Nightingale Faculty of Nursing, Department of Pediatric Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Kadriye Şahin
- Florence Nightingale Faculty of Nursing, Department of Pediatric Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Hande Özgörü
- Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Burstein B, Lirette MP, Beck C, Chauvin-Kimoff L, Chan K. La prise en charge des nourrissons de 90 jours ou moins, fiévreux mais dans un bon état général. Paediatr Child Health 2024; 29:50-66. [PMID: 38332975 PMCID: PMC10848124 DOI: 10.1093/pch/pxad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/15/2022] [Indexed: 02/10/2024] Open
Abstract
On constate des pratiques très variées en matière d'évaluation et de prise en charge des jeunes nourrissons fiévreux. Bien que la plupart des jeunes nourrissons fiévreux mais dans un bon état général soient atteints d'une maladie virale, il est essentiel de détecter ceux qui sont à risque de présenter des infections bactériennes invasives, notamment une bactériémie et une méningite bactérienne. Le présent document de principes porte sur les nourrissons de 90 jours ou moins dont la température rectale est de 38,0 °C ou plus, mais qui semblent être dans un bon état général. Il est conseillé d'appliquer les récents critères de stratification du risque pour orienter la prise en charge, ainsi que d'intégrer la procalcitonine à l'évaluation diagnostique. Les décisions sur la prise en charge des nourrissons qui satisfont aux critères de faible risque devraient refléter la probabilité d'une maladie, tenir compte de l'équilibre entre les risques et les préjudices potentiels et faire participer les parents ou les proches aux décisions lorsque diverses options sont possibles. La prise en charge optimale peut également dépendre de considérations pragmatiques, telles que l'accès à des examens diagnostiques, à des unités d'observation, à des soins tertiaires et à un suivi. Des éléments particuliers, tels que la mesure de la température, le risque d'infection invasive à Herpes simplex et la fièvre postvaccinale, sont également abordés.
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Affiliation(s)
- Brett Burstein
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | - Marie-Pier Lirette
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | - Carolyn Beck
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | | | - Kevin Chan
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
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Burstein B, Lirette MP, Beck C, Chauvin-Kimoff L, Chan K. Management of well-appearing febrile young infants aged ≤90 days. Paediatr Child Health 2024; 29:50-66. [PMID: 38332970 PMCID: PMC10848123 DOI: 10.1093/pch/pxad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/15/2022] [Indexed: 02/10/2024] Open
Abstract
The evaluation and management of young infants presenting with fever remains an area of significant practice variation. While most well-appearing febrile young infants have a viral illness, identifying those at risk for invasive bacterial infections, specifically bacteremia and bacterial meningitis, is critical. This statement considers infants aged ≤90 days who present with a rectal temperature ≥38.0°C but appear well otherwise. Applying recent risk-stratification criteria to guide management and incorporating diagnostic testing with procalcitonin are advised. Management decisions for infants meeting low-risk criteria should reflect the probability of disease, consider the balance of risks and potential harm, and include parents/caregivers in shared decision-making when options exist. Optimal management may also be influenced by pragmatic considerations, such as access to diagnostic investigations, observation units, tertiary care, and follow-up. Special considerations such as temperature measurement, risk for invasive herpes simplex infection, and post-immunization fever are also discussed.
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Affiliation(s)
- Brett Burstein
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Marie-Pier Lirette
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Carolyn Beck
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | | | - Kevin Chan
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
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5
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Herreros ML, Barrios A, Sánchez A, Del Valle R, Pacheco M, Gili P. Urine collection methods in precontinent children treated at the paediatric emergency department. Acta Paediatr 2023; 112:550-556. [PMID: 36463432 DOI: 10.1111/apa.16614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/05/2022]
Abstract
AIM To describe the urine collection methods used in precontinent children presenting at the Paediatric Emergency Department (PED) and compare results and contamination rates. METHODS Retrospective observational cohort study that included 1678 urine cultures collected in infants <24 months of age between January 2016 and December 2019. Urine cultures were compared based on collection technique, sex and patient age. RESULTS In total, 60.4% of samples were collected by clean-catch urine collection (CCUC), 26.4% by urethral catheterisation (UC) and 13.2% by urine bag (UB). Contamination rates were 2.9% (95% CI 1.3, 4.4) for UC, 11.3% (95% CI 9.3, 13.2) for CCUC and 23.4% (95% CI 17.8, 29.0) for UB. Significant differences in contamination rates were found between UC and CCUC in the 6-12-month age group (1.9% [95% CI 0.0-4.0] versus 12.0% [95% CI 7.2-16.8] [p < 0.0009]), and between UC and UB for all ages. CONCLUSIONS CCUC is the most common method for urine culture collection in infants <24 months of age at the PED in our centre. UC has the lowest contamination rates, but significant differences were only observed between CCUC and UC in the 6-12-month age group. CCUC is a non-invasive alternative for urine collection in infants.
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Affiliation(s)
- María Luisa Herreros
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Ana Barrios
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Aida Sánchez
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Rut Del Valle
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Mónica Pacheco
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Pablo Gili
- Hospital Universitario Fundación Alcorcón, Alcorcon, Spain
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Brandström P, Hansson S. Urinary Tract Infection in Children. Pediatr Clin North Am 2022; 69:1099-1114. [PMID: 36880924 DOI: 10.1016/j.pcl.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptoms of urinary tract infection (UTI) in young children are nonspecific and urine sampling is challenging. A safe and rapid diagnosis of UTI can be achieved with new biomarkers and culture of clean-catch urine, reserving catheterization or suprapubic aspiration for severely ill infants. Most guidelines recommend ultrasound assessment and use of risk factors to direct further management of children at risk of kidney deterioration. The increasing knowledge of the innate immune system will add new predictors and treatment strategies to the management of UTI in children. Long-term outcome is good for the majority, but individuals with severe scarring can develop hypertension and decline in kidney function.
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Affiliation(s)
- Per Brandström
- Department of Pediatrics, Clinical Science Institute, Sahlgrenska Academy, University of Gothenburg, Gothenburg 416 85, Sweden; Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg 416 85, Sweden.
| | - Sverker Hansson
- Department of Pediatrics, Clinical Science Institute, Sahlgrenska Academy, University of Gothenburg, Gothenburg 416 85, Sweden; Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg 416 85, Sweden
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Nadeem S, Manuel MM, Oke OK, Patel V, Filkins LM, Badawy MK, Park JY, Hennes HM. Association of Pyuria with Uropathogens in Young Children. J Pediatr 2022; 245:208-212.e2. [PMID: 35120990 DOI: 10.1016/j.jpeds.2022.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/08/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the association between uropathogens and pyuria in children <24 months of age. STUDY DESIGN A retrospective study of children <24 months of age evaluated in the emergency department for suspected urinary tract infection (UTI) with paired urinalysis and urine culture during a 6-year period. Bagged urine specimens or urine culture growing mixed/multiple urogenital organisms were excluded. Analysis was limited to children with positive urine culture as defined by the American Academy of Pediatrics clinical practice guideline culture thresholds. RESULTS Of 30 462 children, 1916 had microscopic urinalysis and positive urine culture. Urine was obtained by transurethral in-and-out catheterization in 98.3% of cases. Pyuria (≥5 white blood cells per high-powered field) and positive leukocyte esterase (small or more) on the urine dipstick were present in 1690 (88.2%) and 1692 (88.3%) of the children respectively. Children with non-Escherichia coli species were less likely to exhibit microscopic pyuria than children with E coli (OR 0.24, 95% CI 0.17-0.34) with more pronounced effect on Enterococcus and Klebsiella (OR 0.08, 95% CI 0.03-0.18 and OR 0.18, 95% CI 0.11-0.27 respectively). Similarly, positive leukocyte esterase was less frequently seen in non-E coli uropathogens compared with E coli. CONCLUSIONS Pyuria and leukocyte esterase are not sensitive markers to identify non-E coli UTI in young children. More sensitive screening biomarkers are needed to identify UTI with these uropathogens.
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Affiliation(s)
| | - Matthias M Manuel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Vatsal Patel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Laura M Filkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mohamed K Badawy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Halim M Hennes
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
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Bagnasco F, Piaggio G, Mesini A, Mariani M, Russo C, Saffioti C, Losurdo G, Palmero C, Castagnola E. Epidemiology of Antibiotic Resistant Pathogens in Pediatric Urinary Tract Infections as a Tool to Develop a Prediction Model for Early Detection of Drug-Specific Resistance. Antibiotics (Basel) 2022; 11:antibiotics11060720. [PMID: 35740127 PMCID: PMC9220059 DOI: 10.3390/antibiotics11060720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Antibiotic resistance is an increasing problem, especially in children with urinary tract infections. Rates of drug-specific resistant pathogens were reported, and an easy prediction model to guide the clinical decision-making process for antibiotic treatment was proposed. Data on microbiological isolation from urinoculture, between January 2007−December 2018 at Istituto Gaslini, Italy, in patients aged <19 years were extracted. Logistic regression-based prediction scores were calculated. Discrimination was determined by the area under the receiver operating characteristic curve; calibration was assessed by the Hosmer and Lemeshow test and the Spiegelhalterz test. A total of 9449 bacterial strains were isolated in 6207 patients; 27.2% were <6 months old at the first episode. Enterobacteriales (Escherichia coli and other Enterobacteriales) accounted for 80.4% of all isolates. Amoxicillin-clavulanate (AMC) and cefixime (CFI) Enterobacteriales resistance was 32.8% and 13.7%, respectively, and remained quite stable among the different age groups. On the contrary, resistance to ciprofloxacin (CIP) (overall 9.6%) and cotrimoxazole (SXT) (overall 28%) increased with age. After multivariable analysis, resistance to AMC/CFI could be predicted by the following: sex; age at sampling; department of admission; previous number of bacterial pathogens isolated. Resistance to CIP/SXT could be predicted by the same factors, excluding sex. The models achieved very good calibration but moderate discrimination performance. Specific antibiotic resistance among Enterobacteriales could be predicted using the proposed scoring system to guide empirical antibiotic choice. Further studies are needed to validate this tool.
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Affiliation(s)
- Francesca Bagnasco
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
- Correspondence:
| | - Giorgio Piaggio
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Alessio Mesini
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Marcello Mariani
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genova, Italy
| | - Chiara Russo
- Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy;
| | - Carolina Saffioti
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Giuseppe Losurdo
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Candida Palmero
- Clinical Pathology Laboratory and Microbiology, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Elio Castagnola
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
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Adasevic B, Turudic D, Milosevic D. Commentary: Serum Calprotectin Is a Valid Biomarker in Distinction of Bacterial Urinary Tract Infection From Viral Respiratory Illness in Children Under 3 Years of Age. Front Pediatr 2022; 10:921939. [PMID: 35799692 PMCID: PMC9253375 DOI: 10.3389/fped.2022.921939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Boris Adasevic
- Department of Pediatrics, General Hospital Zabok and Hospital of Croatian Veterans, Bracak, Croatia
| | - Daniel Turudic
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Danko Milosevic
- Department of Pediatrics, General Hospital Zabok and Hospital of Croatian Veterans, Bracak, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Rivas-García A, Lorente-Romero J, López-Blázquez M, Rodríguez-Jiménez C, Castro-Rodríguez C, Míguez-Navarro MC. Contamination in Urine Samples Collected Using Bladder Stimulation and Clean Catch Versus Urinary Catheterization in Infants Younger Than 90 Days. Pediatr Emerg Care 2022; 38:e89-e93. [PMID: 32555017 DOI: 10.1097/pec.0000000000002154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to compare the risk of contamination for urine samples collected from patients younger than 90 days using 2 different techniques: bladder stimulation and "clean catch" (CC) and urinary catheterization (CATH). METHODS A case-control study was carried out in the pediatric emergency room of a tertiary hospital between January 2016 and September 2017. All urine samples collected from patients younger than 90 days by CC or CATH were included. The incidence of contaminated urine samples was compared for both methods, and the risk of contamination was estimated using univariate and multivariate analyses. RESULTS A total of 473 urine samples were collected, 310 via CATH (65.5%) and 163 via CC (34.5%). The median age was 1.4 months (interquartile range, 0.8-2.1 months), and 54.1% were males. Seventeen patients had a history of urinary tract infection (3.6%), and 16 were diagnosed with a congenital urorenal anomaly (3.4%). Sixteen urine samples were found to be contaminated (3.4%): 5 collected via CATH (1.6%) and 11 via CC (6.8%). The univariate analysis revealed a greater risk of contamination in specimens obtained using CC versus CATH (odds ratio, 4.41; 95% confidence interval, 1.51-12.93), and the multivariate analysis confirmed CC collection as an independent risk factor for contamination (odds ratio, 5.61; 95% confidence interval, 1.83-17.19). CONCLUSIONS The number of contaminated urine samples in infants younger than 90 days in our pediatric emergency department is low. However, using the CC urine collection technique seems to be an independent risk factor for sample contamination.
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Affiliation(s)
- Arístides Rivas-García
- From the Pediatric Emergency Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
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11
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Ravichandran Y, Parker S, Farooqi A, DeLaroche A. Bladder Stimulation for Clean Catch Urine Collection: Improved Parent and Provider Satisfaction. Pediatr Emerg Care 2022; 38:e29-e33. [PMID: 34475366 DOI: 10.1097/pec.0000000000002524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Previous studies have demonstrated the efficacy of fluid intake with suprapubic and lumbar paravertebral massage for clean catch urine (CCU) collection in infants. We investigated the acceptability and feasibility of integrating this bladder stimulation technique (BST) into routine care in the pediatric emergency department (PED). METHODS This was a prospective cohort study. Infants less than 6 months of age requiring a urinalysis and urine culture as part of their PED visit were recruited. All PED nurses and technicians received a standardized training outlining the BST using a video module and print materials. Success rates, bacterial contamination, parental perception of patient distress, and parent and provider satisfaction with the BST for CCU collection were compared with urethral catheterization. RESULTS A total of 124 patients were recruited. The BST was successful in 38% (47/124) with a median time to void of 73 seconds (interquartile range: 19, 151). The BST was more likely to be successful in infants less than 90 days (53%; 95% confidence interval, 0.075-0.046; P = 0.005). A urinary tract infection was diagnosed in 4% of patients, with no significant differences between BST (1/47; 2%) and catheterization (4/59; 7%; P = 0.65). Patients experienced less discomfort during the BST compared with catheterization (mean numeric rating scale score, 2/10 vs 6/10; P < 0.001), and the BST was viewed positively by both parents and providers. Compared with catheterization, parents were significantly more satisfied with the BST (BST, 98%; catheterization, 58%; P < 0.001) and were more likely to consent to the BST in the future (BST, 98%; catheterization, 69%; P < 0.001). Most providers reported that the BST was well tolerated by participants (46/47; 98%), and providers felt that the BST improved parental satisfaction with the clinical encounter (46/47; 98%). CONCLUSION The BST for CCU collection is a well-tolerated and well-received approach that can easily be implemented into clinical practice with minimal training.
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Affiliation(s)
| | - Sarah Parker
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
| | - Ahmad Farooqi
- Children's Research Center of Michigan, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
| | - Amy DeLaroche
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
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12
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Boon HA, Lenaerts W, Van Aerde C, Verbakel JY. Outpatient urine collection methods for paediatric urinary tract infections: Systematic review of diagnostic accuracy studies. Acta Paediatr 2021; 110:3170-3179. [PMID: 34236715 DOI: 10.1111/apa.16027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
AIM To investigate the diagnostic test accuracy of urine collection methods for urinary tract infections in outpatient children. METHODS A systematic literature review until April 2021 (Medline, Web of Science, Embase, Cinahl) to examine the diagnostic test accuracy of urine culture on collection methods for urinary tract infection in outpatient children below 18 years. Contamination rates were studied as secondary outcome. The risk of bias was assessed using the QUADAS-2 criteria. Two-by-two tables were extracted in duplicate to calculate sensitivities, specificities, and likelihood ratios with 95% confidence intervals. RESULTS The search identified seven relevant studies. Clean catch compared to catheterization in children less than 90 days showed a sensitivity and specificity of 97% and 89% (95% CI: 84%-100% and 67%-99%), respectively. Adhesive bags compared to catheterization showed a sensitivity of 83% (95% CI: 75%-90%) and specificity of 91% (95% CI: 83%-96%). There was a similar diagnostic accuracy when comparing urine sampling by means of adhesive bags versus nappy pads. The contamination rate was 5% for clean catch, 30%-80% for adhesive bags and 64% for nappy pads. CONCLUSION Nappy pads and adhesive bags are easy to use with comparable accuracy but are extremely prone to contamination. Clean-catch urine sampling might be an accurate alternative in young infants in ambulatory care.
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Affiliation(s)
- Hanne Ann Boon
- EPI‐CentreAcademic Centre for General PracticeKU Leuven Leuven Belgium
| | - Wouter Lenaerts
- EPI‐CentreAcademic Centre for General PracticeKU Leuven Leuven Belgium
| | - Cedric Van Aerde
- EPI‐CentreAcademic Centre for General PracticeKU Leuven Leuven Belgium
| | - Jan Y. Verbakel
- EPI‐CentreAcademic Centre for General PracticeKU Leuven Leuven Belgium
- Nuffield Department of Primary Care Health Sciences University of OxfordRadcliffe Observatory Quarter Oxford UK
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13
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Ismail H, Chowdhary H, Taira BR, Moiane S, Faruk L, Alface B, Mohole J, Gonçalves O, Hartford EA, Buck WC. Paediatric emergency care at an academic referral hospital in Mozambique. Afr J Emerg Med 2021; 11:410-415. [PMID: 34703732 PMCID: PMC8524113 DOI: 10.1016/j.afjem.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/30/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Improved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique. Methods This was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country. All children 0–14 years of age seen in the 12-month period from August 2018–July 2019 were included. Descriptive statistical analyses were performed. Results Data from 346 days and 64,966 patient encounters were analyzed. The large majority of patients (96.4%) presented directly to the PED without referral from a lower level facility. An average of 188 patients was seen per day, with significant seasonal variation peaking in March (292 patients/day). The most common diagnoses were upper respiratory infections (URI), gastroenteritis, asthma, and dermatologic problems. The highest acuity diagnoses were neurologic problems (59%), asthma (57%), and neonatal diagnoses (50%). Diagnoses with the largest proportion of admissions included neurologic problems, malaria, and neonatal diagnoses. Rapid malaria antigen tests were the most commonly ordered laboratory test across all diagnostic categories; full blood count (FBC) and chemistries were also commonly ordered. Urinalysis and HIV testing were rarely done in the PED. Conclusion This epidemiologic profile of illness seen in the HCM PED will allow for improved resource utilisation. We identified opportunities for evidence-based care algorithms for common diagnoses such as respiratory illness to improve patient care and flow. The PED may also be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis.
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14
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Urine collection methods for infants under 3 months of age in clinical practice. Pediatr Nephrol 2021; 36:3899-3904. [PMID: 34100109 DOI: 10.1007/s00467-021-05142-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Methods of urine collection used in precontinent children are a controversial issue. Definitive diagnosis of urinary tract infection (UTI) requires an uncontaminated urine culture. We aimed to describe methods used to collect urine for culture in infants under 3 months of age and compare results and contamination rates. METHODS This retrospective observational cohort study included 721 urine cultures collected from infants <3 months of age at the Hospital Universitario Infanta Sofía, Madrid, between January 2016 and December 2019. Urine cultures were compared based on collection technique, sex, and patient age. RESULTS Median patient age was 36 days and 54.6% were male. In total, 592 (82.1%) samples were collected using clean-catch urine stimulation technique (CCUST), 77 (10.7%) by urethral catheterization (UC) and 52 (7.2%) by urine bag (UB). Positive cultures were obtained in 11.7% (95% confidence interval [CI] 9.1, 14.3) of CCUST samples and in 28.6% (95% CI 18.5, 38.7) of UC samples (p<0.001). The contamination rate was 13.7% (95% CI 10.9, 16.4] for CCUST, 23.1% (95% CI 11.6, 34.6) for UB and 5.2% (95% CI 0.2, 10.2) for UC, with statistically significant differences (p=0.007) between UB and UC collection. CONCLUSIONS CCUST is the most commonly used method in our hospital for collecting urine in infants younger than 3 months. The contamination rate of UC is lower but not significantly different to that of CCUST. Urine collection by CCUST serves as a non-invasive alternative to UC for diagnosis of UTI in infants under 3 months of age in routine clinical practice. Graphical abstract.
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Guri A, Hurvitz Florenthal M, Scheier E, Mahlab-Guri K, Balla U. Contamination rates of different methods of urine culture collection in children: A retrospective cohort study. J Paediatr Child Health 2021; 57:1281-1287. [PMID: 33760325 DOI: 10.1111/jpc.15457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
AIM Urinary tract infection is a common cause of paediatric morbidity. However, there is no consensus on the default method for urine culture collection in children. This study aimed to examine the contamination rates of different urine collection methods. METHODS This was a retrospective cohort study in a paediatric emergency department. Data were collected from electronic health records on all children whose urine culture samples were obtained in the paediatric emergency department between March 2018 and March 2019. Different methods of urine collection included the midstream (MS) method, clean catch (CC), transurethral bladder catheterisation and suprapubic aspiration. Contamination rates and positive urine culture rates were calculated and compared for sex, age, and collection method. RESULTS Urine culture samples were collected from 1507 children. There were 284 (18.8%) cultures that were positive with significant growth and 52 (3.5%) that were defined as 'contaminated'. The contamination rates for the midstream method in toilet-trained children were 1.6% (10/609), 4.9% (17/348) for CC in pre-continent children, 4.9% (25/515) for transurethral bladder catheterisation and 0% (0/35) (P = 0.006) for suprapubic aspiration. There was no significant difference in contamination rates of urine cultures collected by CC and catheterisation in the compared groups. The rates of positive cultures in the subgroup of children with high suspicion for Urinary tract infection were also found to be similar. CONCLUSIONS Our study shows that CC is non-inferior to catheterisation for collecting urine cultures in young children.
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Affiliation(s)
- Alex Guri
- Division of Paediatrics, Kaplan Medical Center, Rehovot, Israel.,The School of Medicine, The Hebrew University and Hadassah Medical Center, Jerusalem, Israel
| | - Michal Hurvitz Florenthal
- Division of Paediatrics, Kaplan Medical Center, Rehovot, Israel.,The School of Medicine, The Hebrew University and Hadassah Medical Center, Jerusalem, Israel
| | - Eric Scheier
- Division of Paediatrics, Kaplan Medical Center, Rehovot, Israel.,The School of Medicine, The Hebrew University and Hadassah Medical Center, Jerusalem, Israel
| | - Keren Mahlab-Guri
- The School of Medicine, The Hebrew University and Hadassah Medical Center, Jerusalem, Israel.,Department of Allergy and Clinical immunology, Kaplan Medical Center, Rehovot, Israel
| | - Uri Balla
- Division of Paediatrics, Kaplan Medical Center, Rehovot, Israel.,The School of Medicine, The Hebrew University and Hadassah Medical Center, Jerusalem, Israel
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Akca Caglar A, Tekeli A, Karacan CD, Tuygun N. Point-of-Care Ultrasound-Guided Versus Conventional Bladder Catheterization for Urine Sampling in Children Aged 0 to 24 Months. Pediatr Emerg Care 2021; 37:413-416. [PMID: 34397676 DOI: 10.1097/pec.0000000000002490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES It can be difficult to obtain urine samples, especially in children aged 0 to 24 months who have not yet completed toilet training. Bladder catheterization is a common method for urine sampling in this age group. However, if the bladder is not adequately filled, this process fails and repeat catheterization is necessary. Point-of-care ultrasonography (POCUS) is often used to assist invasive procedures in the pediatric emergency department. This study aimed to compare success rates of bladder catheterization in patients with and without POCUS to guide the timing of the procedure. METHODS This was a prospective cohort study of children 0 to 24 months presenting to a pediatric emergency department in a tertiary center hospital. Patients were divided into 2 groups; the one group received conventional catheterization (CC group) without POCUS and the other group had catheterization after POCUS (POCUS group). The transverse and anterior-posterior diameter measurements of the bladder were obtained from one view in the transverse orientation using the (6-3 MHz) convex probe. Successful catheterization was defined by obtaining 3 mL or more of urine. RESULTS A total of 110 patients were included in the study, with 56 in the POCUS group and 54 in the CC group. There was no difference between the mean age and sex of the groups. The success rates of obtaining urine samples were 93% and 78% in the POCUS group and CC group, respectively. This difference was statistically significant (P = 0.03). No significant difference was found between measurements of bladder catheterizations with and without obtaining 3 mL or greater urine volumes in the ultrasound group (P > 0.05). CONCLUSIONS The use of POCUS during bladder catheterization in children was found to be effective and successful. In addition, the detection of any amount of urine in the bladder using POCUS increases the success rate of bladder catheterization.
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Affiliation(s)
- Ayla Akca Caglar
- From the Clinic of Pediatric Emergency, University of Health Sciences, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
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Pragmatic evaluation of a midstream urine collection technique for infants in the emergency department. CAN J EMERG MED 2021; 22:665-672. [PMID: 32383423 DOI: 10.1017/cem.2020.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Our objective was to examine the performance characteristics of a bladder stimulation technique for urine collection among infants presenting to the emergency department (ED). METHODS This prospective cohort study enrolled a convenience sample of infants aged ≤ 90 days requiring urine testing in the ED. Infants were excluded if critically ill, moderately to severely dehydrated, or having significant feeding issues. Bladder stimulation consisted of finger tapping on the lower abdomen with or without lower back massage while holding the child upright. The primary outcome was successful midstream urine collection within 5 minutes of stimulation. Secondary outcomes included sample contamination, bladder stimulation time for successful urine collection, and perceived patient distress on a 100-mm visual analog scale (VAS). RESULTS We enrolled 151 infants and included 147 in the analysis. Median age was 53 days (interquartile range [IQR] 27-68 days). Midstream urine sample collection using bladder stimulation was successful in 78 infants (53.1%; 95% confidence interval [CI] 45-60.9). Thirty-nine samples (50%) were contaminated. Most contaminated samples (n = 31; 79.5%) were reported as "no significant growth" or "growth of 3 or more organisms". Median bladder stimulation time required for midstream urine collection was 45 seconds (IQR 20-120 seconds). Mean VAS for infant distress was 22 mm (standard deviation 23 mm). CONCLUSIONS The success rate of this bladder stimulation technique was lower than previously reported. The contamination rate was high, however most contaminated specimens were easily identified and had no clinical impact.
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Mahdipour S, Saadat SNS, Badeli H, Rad AH. Strengthening the success rate of suprapubic aspiration in infants by integrating point-of-care ultrasonography guidance: A parallel-randomized clinical trial. PLoS One 2021; 16:e0254703. [PMID: 34265015 PMCID: PMC8282064 DOI: 10.1371/journal.pone.0254703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is a common disease in childhood. A sterile collection of urine samples using suprapubic aspiration (SPA) and bladder catheterization (BC) is helpful for rapid and accurate diagnosis of UTI in infants. With the advent of point-of-care ultrasound (POCUS), the use of ultrasound by non-radiologists at the patient's bedside, great advancement has been noticed in various medical fields. Considering the importance and advantages of using POCUS in the physical examination and guiding procedures, the authors aimed to compare urine sampling's success rate by SPA, BC, and POCUS guided SPA (POCUS-SPA) in infants performed by three pediatricians. MATERIALS AND METHODS This study is a randomized clinical trial conducted on 114 neonates and infants with suspected UTI admitted to 17-Shahrivar children's hospital from April 2017 to September 2019. Neonates and infants were randomly assigned to three groups of BC, SPA, and POCUS-SPA. The primary outcome was the success of sampling defined by obtaining 1cc of urine in each method. The secondary outcome was assessing the pain level. RESULTS Results showed that the POCUS-SPA had the highest success rate in urine sampling, and a statistically significant relation was noted among the three groups (P = 0.0001). From 38 patients in each group, 37 patients of POCUS-SPA (97.4%), 34 patients of BC (89.5%), and 23 patients of SPA (60.5%) had a successful sampling. Most of the patients in all three groups experienced severe pain. CONCLUSIONS In the current study, results showed that the POCUS-SPA significantly increased the success rate of urine sampling and most of the patients in all three groups had severe pain. Based on the shortage of access to radiologists in emergency setups, it seems that the POCUS-SPA by the pediatricians can be one of the most appropriate and applicable diagnostic methods in infants with UTI.
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Affiliation(s)
- Sadroddin Mahdipour
- Neonatologist, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Hamidreza Badeli
- Pediatric Nephrologist, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Afagh Hassanzadeh Rad
- BS of Midwifery, PhD of Linguistics, Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Desjardins MP, Gaucher N, Gravel J, Lebel D, Gouin S. A randomized double-blind trial comparing the effect on pain of an oral sucrose solution versus placebo in children 1-3 months old needing bladder catheterization. CAN J EMERG MED 2021; 23:655-662. [PMID: 34037975 DOI: 10.1007/s43678-021-00130-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/29/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The efficacy of oral sweet solutions to decrease pain in infants during painful procedures remains uncertain. This study aimed to compare the efficacy of an oral sucrose solution versus placebo in reducing pain during bladder catheterization in infants in the Emergency Department (ED). METHODS A randomized, double-blind clinical trial was conducted in a pediatric university-affiliated hospital ED. Infants 1-3 months old were recruited and randomly allocated to receive 2 ml of sucrose or placebo, 2 min before bladder catheterization. The primary outcome measure was the difference in pain scores as assessed by the Face, Legs, Activity, Cry and Consolability (FLACC) Pain Scale during procedure. Secondary outcome measures were the difference in pain scores using the Neonatal Infant Pain Scale (NIPS), crying time, variations in heart rate and adverse events. RESULTS Eighty-three participants were recruited and completed the study, 41 and 42 in the sucrose and placebo groups, respectively. The mean difference in FLACC scores compared to baseline was 5.3 in the sucrose group vs. 6.4 in the placebo group during catheterization. There were no differences in FLACC scores or NIPS scores measured at 1, 3 and 5 min post procedure. Mean crying times were similar: 97 vs. 110 s. No significant difference was found in participants' heart rate variations. No adverse events were reported. CONCLUSIONS In infants undergoing bladder catheterization in the ED, administration of an oral sweet solution was not associated with lower pain as measured by the FLACC and NIPS scales. Participants' heart rate variations and crying times did not change when sucrose was provided.
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Affiliation(s)
- Marie Pier Desjardins
- Department of Pediatrics Emergency, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Nathalie Gaucher
- Department of Pediatrics Emergency, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Jocelyn Gravel
- Department of Pediatrics Emergency, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Denis Lebel
- Department of Pharmacy, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Serge Gouin
- Department of Pediatrics Emergency, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
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Diviney J, Jaswon MS. Urine collection methods and dipstick testing in non-toilet-trained children. Pediatr Nephrol 2021; 36:1697-1708. [PMID: 32918601 PMCID: PMC8172492 DOI: 10.1007/s00467-020-04742-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 11/03/2022]
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.
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Affiliation(s)
- James Diviney
- Department of Paediatrics, Whittington Hospital, London, UK.
| | - Mervyn S. Jaswon
- grid.417095.e0000 0004 4687 3624Department of Paediatrics, Whittington Hospital, London, UK ,grid.22098.310000 0004 1937 0503Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Swiss consensus recommendations on urinary tract infections in children. Eur J Pediatr 2021; 180:663-674. [PMID: 32621135 PMCID: PMC7886823 DOI: 10.1007/s00431-020-03714-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 05/10/2020] [Accepted: 06/02/2020] [Indexed: 12/24/2022]
Abstract
The kidneys and the urinary tract are a common source of infection in children of all ages, especially infants and young children. The main risk factors for sequelae after urinary tract infections (UTI) are congenital anomalies of the kidney and urinary tract (CAKUT) and bladder-bowel dysfunction. UTI should be considered in every child with fever without a source. The differentiation between upper and lower UTI is crucial for appropriate management. Method of urine collection should be based on age and risk factors. The diagnosis of UTI requires urine analysis and significant growth of a pathogen in culture. Treatment of UTI should be based on practical considerations regarding age and presentation with adjustment of the initial antimicrobial treatment according to antimicrobial sensitivity testing. All children, regardless of age, should have an ultrasound of the urinary tract performed after pyelonephritis. In general, antibiotic prophylaxis is not recommended.Conclusion: Based on recent data and in line with international guidelines, multidisciplinary Swiss consensus recommendations were developed by members of Swiss pediatric infectious diseases, nephrology, and urology societies giving the clinician clear recommendations in regard to diagnosis, type and duration of therapy, antimicrobial treatment options, indication for imaging, and antibiotic prophylaxis. What is Known: • Urinary tract infections (UTI) are a common and important clinical problem in childhood. Although children with pyelonephritis tend to present with fever, it can be difficult on clinical grounds to distinguish cystitis from pyelonephritis, particularly in young children less than 2 years of age. • Method of urine collection is based on age and risk factors. The diagnosis of UTI requires urine analysis and significant growth of a pathogen in culture. What is New: • Vesicoureteric reflux (VUR) remains a risk factor for UTI but per se is neither necessary nor sufficient for the development of renal scars. Congenital anomalies of the kidney and urinary tract (CAKUT) and bladder-bowel dysfunction play a more important role as causes of long-term sequelae. In general, antibiotic prophylaxis is not recommended. • A switch to oral antibiotics should be considered already in young infants. Indications for invasive imaging are more restrictive and reserved for patients with abnormal renal ultrasound, complicated UTI, and infections with pathogens other than E. coli.
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Mulcrone AE, Parikh M, Ahmad FA. Reducing infant catheterization in the emergency department through clean-catch urine collection. J Am Coll Emerg Physicians Open 2020; 1:1533-1541. [PMID: 33392562 PMCID: PMC7771792 DOI: 10.1002/emp2.12211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Our emergency department (ED) traditionally relied on urethral catheterization to obtain urine cultures when evaluating infants for urinary tract infections (UTIs). Catheterization is associated with adverse effects, and recent studies have demonstrated clean-catch urine methods can be successfully used to obtain urine cultures. We pursued a quality improvement (QI) initiative aimed at decreasing the frequency of urethral catheterizations in our ED by using an established clean-catch technique to obtain infant urine cultures. METHODS We implemented a clean-catch urine collection method, which we entitled "Bladder Massage," for infants 0-6 months of age needing a urine culture in our ED. Exclusions included critical illness, known urologic abnormality, or prior UTI diagnosis. Our primary interventions were educational initiatives. We retrospectively collected data regarding the use of bladder massage. Our balancing measure was the contamination rate of urine cultures obtained via bladder massage technique compared to catheterization. RESULTS In our first-year post-implementation, we identified 334 eligible patients. Bladder massage was attempted on 136/334 (40.7%) eligible infants, with 87/136 (64%) successful attempts, thus avoiding catheterization in 26.1% of patients. Our baseline contamination rate from catheterization was 8/488 (1.6%), compared to 10/87 (12%) using bladder massage (P < 0.001), with 9/10 contaminants from female patients. CONCLUSION We successfully introduced a method for clean-catch urine cultures in our pediatric ED, averting the need for urethral catheterization in many well-appearing infants. Ongoing efforts must focus on reduction of contamination in females, increased technique usage, and electronic health record changes to facilitate documentation to continue method use.
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Affiliation(s)
- Amanda E. Mulcrone
- Department of PediatricsWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
- St. Louis Children's HospitalSt. LouisMissouriUSA
- Department of PediatricsBaylor College of MedicineSection of Emergency MedicineHoustonTexasUSA
| | - Manas Parikh
- Department of PediatricsWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
- St. Louis Children's HospitalSt. LouisMissouriUSA
- Erie Family Health CenterChicagoIllinoisUSA
| | - Fahd A. Ahmad
- Department of PediatricsWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
- St. Louis Children's HospitalSt. LouisMissouriUSA
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Point-of-care ultrasound before attempting clean-catch urine collection in infants: a randomized controlled trial. CAN J EMERG MED 2020; 21:646-652. [PMID: 31006399 DOI: 10.1017/cem.2019.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE A new non-invasive bladder stimulation technique has been described to obtain clean-catch urine specimens in infants. This study aimed to evaluate if point-of-care ultrasound (POCUS) guided feeding protocol to measure bladder volume prior to stimulation techniques improves clean-catch urine collection success. METHODS A prospective randomized controlled trial study was conducted in a tertiary care pediatric emergency department. Infants aged less than 6 months needing a urine sample were randomized to either POCUS group or feeding group (standard procedure) before performing a standardized clean-catch urine stimulation technique. In the POCUS group, a feeding period was permitted if the bladder width was less than 2 cm, otherwise the clean-catch urine was performed immediately. The primary outcome was the success of the procedure defined by the collection of at least 2 mL of urine, obtained within 300 seconds of bladder stimulation manoeuvres. It was estimated that the recruitment of 200 children was necessary to yield 80% power to identify an improvement of 20% in the success rate. RESULTS A total of 201 infants were included. The procedure was not more successful in the POCUS group (48%) compared to the feeding group (54%) (Difference: 6.5%; 95% CI: -7.3 to 19.8%). The mean time to collect urine samples from randomization to sample collection was not different between the two groups. CONCLUSIONS Our study failed to show a benefit of using POCUS to improve the success rate of stimulated clean-catch urine. Moreover, the importance of the feeding period prior to clean-catch urine manoeuvres should be evaluated further. CLINICAL TRIAL REGISTRATION NCT02751671.
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Lorenzo AJ, Rickard M, Santos JD. The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children. Pediatr Nephrol 2020; 35:1395-1408. [PMID: 30671629 DOI: 10.1007/s00467-019-4193-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 02/03/2023]
Abstract
Urinary tract infections (UTIs) are a common reason for referral to pediatric specialists and the risk profile of these children is influenced by age, sex, and underlying urinary tract abnormalities. UTIs in toilet-trained children represent a different entity than confirmed, febrile UTIs that occur in infants, impacted by suboptimal bladder habits, bladder dysfunction, constipation, or a combination of these factors. A comprehensive literature search was conducted using PubMed and MEDLINE and search terms included recurrent UTI, VUR, bladder and bowel dysfunction (BBD), constipation, lower urinary tract symptoms, and voiding dysfunction. Common presenting symptoms of UTI in children include fever (> 38 °C) with or without "traditional" lower urinary tract symptoms (LUTS) such as dysuria, malodorous urine, frequency, urgency, and incontinence. However, many infections in older children are afebrile episodes-consisting primarily of LUTS-which may or may not be confirmed with biochemical and/or microbiological evidence. Therefore, when evaluating toilet-trained children with recurrent UTIs, it is paramount to consider dysfunctional elimination as an underlying cause, diagnose, and treat it prior to indicating surgical options, even in the presence of VUR or other anatomical abnormalities. Although the impact of bladder function on the risk of infections is important, so is the accurate diagnosis and initial evaluation. This review article will focus on an often overlooked yet critical factor: the impact of bladder function, particularly for toilet-trained children, as well as the importance of implementing bladder training strategies, aggressive management of constipation, and pharmacological management as necessary.
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Affiliation(s)
- Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. .,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
| | - Mandy Rickard
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Joana Dos Santos
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
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Abstract
Urine samples are commonly collected from young children to diagnose or exclude urinary tract infections, but collection from precontinent children is challenging. Each collection method has advantages and limitations. Non-invasive methods (urine pads, bags, clean catch) are convenient but can be time-consuming and are limited by sample contamination. Voiding stimulation methods (bladder-lumbar stimulation, Quick-Wee) can expedite clean catch collection. Invasive methods (catheter, suprapubic aspiration) can be more reliable, but require expertise to perform and cause pain for the child. This article reviews each collection method, and describes collection procedures, indications and strategies to optimise success and reduce contamination.
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Affiliation(s)
- Jonathan Kaufman
- Department of General Practice Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Paediatrics, Sunshine Hospital, St Albans, Victoria, Australia.,Health Services Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Chandy M, Dewey A, Fogg C, Pilkington K. Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review. Emerg Med J 2020; 37:162-169. [PMID: 32033959 DOI: 10.1136/emermed-2019-208580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 01/01/2020] [Accepted: 01/04/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Urinary tract infection requires collection of a sterile urine specimen for diagnosis, which is difficult and time consuming in pre-continent children. This systematic review summarises evidence of the effectiveness of bladder stimulation techniques on urine collection in pre-continent children, compared with standard techniques. METHODS MEDLINE, PubMed, EMBASE and CINAHL were searched to May 2019. Selection, data extraction, risk of bias and quality assessment were undertaken by two independent reviewers. Inclusion: (1) all study designs; (2) pre-continent, age <3 years receiving bladder stimulation techniques; (3) outcomes including time to urine collection or contamination rates; (4) English-language articles. Exclusion: coexisting neurological disorders. RESULTS Three randomised controlled trials (RCTs) were identified using three techniques in 568 participants aged 1 day to 35 months. Two RCTs demonstrated an increased success in voiding within 5 min, one using a finger tapping and lumbar paravertebral massage technique and the other cold saline-soaked gauze rubbed over the suprapubic region, compared with no active intervention. A third RCT using a mechanical vibration device demonstrated no difference in time to voiding from advice alone. Non-randomised studies compared different temperatures for the gauze intervention and tapping alone versus urine bags. Six uncontrolled studies tested the finger tapping and massage technique. Risk of bias was low for one RCT and unclear for two RCTs with the other studies rated poor to fair quality. Overall, the evidence on success rates was graded low for tapping plus massage and moderate for the gauze rubbing intervention. Adverse effects included crying and mild distress. DISCUSSION The results suggest a positive effect of stimulation techniquesbut lack of replication in rigorous RCTs and heterogeneity of techniques and outcomes assessed prevent conclusive recommendations being made. Further RCTs are required comparing non-invasive stimulation methods and assessing time to successful collection, contamination rates, adverse effects, caregiver and clinical staff acceptability.
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Affiliation(s)
- Mathew Chandy
- Emergency Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Ann Dewey
- School of Health and Care Professions, University of Portsmouth, Portsmouth, Hampshire, UK
| | - Carole Fogg
- Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Karen Pilkington
- School of Health and Care Professions, University of Portsmouth, Portsmouth, Hampshire, UK
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Ammenti A, Alberici I, Brugnara M, Chimenz R, Guarino S, La Manna A, La Scola C, Maringhini S, Marra G, Materassi M, Morello W, Nicolini G, Pennesi M, Pisanello L, Pugliese F, Scozzola F, Sica F, Toffolo A, Montini G. Updated Italian recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children. Acta Paediatr 2020; 109:236-247. [PMID: 31454101 PMCID: PMC7004047 DOI: 10.1111/apa.14988] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022]
Abstract
AIM Our aim was to update the recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children, which were endorsed in 2012 by the Italian Society of Pediatric Nephrology. METHODS The Italian recommendations were revised on the basis of a review of the literature published from 2012 to October 2018. We also carried out an ad hoc evaluation of the risk factors to identify children with high-grade vesicoureteral reflux or renal scarring, which were published in the previous recommendations. When evidence was not available, the working group held extensive discussions, during various meetings and through email exchanges. RESULTS Four major modifications have been introduced. The method for collecting urine for culture and its interpretation has been re-evaluated. We have reformulated the algorithm that guides clinical decisions to proceed with voiding cystourethrography. The suggested antibiotics have been revised, and we have recommended further restrictions of the use of antibiotic prophylaxis. CONCLUSION These updated recommendations have now been endorsed by the Italian Society of Pediatric Nephrology and the Italian Society for Pediatric Infectivology. They can also be used to compare other recommendations that are available, as a worldwide consensus in this area is still lacking.
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Affiliation(s)
- Anita Ammenti
- Pediatric Polyspecialistic GroupPoliambulatorio Medi‐SaluserParmaItaly
| | - Irene Alberici
- Department of Woman and Child's HealthUniversity of PadovaPadovaItaly
| | | | - Roberto Chimenz
- Pediatric Nephrology and Dialysis UnitDepartment of PediatricsG. Martino HospitalUniversity of MessinaMessinaItaly
| | - Stefano Guarino
- Department of WomanChild and of General and Specialized SurgeryUniversità degli Studi della Campania L. VanvitelliNaplesItaly
| | - Angela La Manna
- Department of WomanChild and of General and Specialized SurgeryUniversità degli Studi della Campania L. VanvitelliNaplesItaly
| | - Claudio La Scola
- Nephrology and Dialysis UnitDepartment of PediatricsAzienda Ospedaliero Universitaria Sant'Orsola‐MalpighiBolognaItaly
| | | | - Giuseppina Marra
- Pediatric NephrologyDialysis and Transplant UnitFondazione Ca'Granda, IRCCS Policlinico di MilanoMilanoItaly
| | | | - William Morello
- Pediatric NephrologyDialysis and Transplant UnitFondazione Ca'Granda, IRCCS Policlinico di MilanoMilanoItaly
| | | | - Marco Pennesi
- Department of PediatricsInstitute for Child and Maternal HealthIRCCS Burlo GarofoloTriesteItaly
| | | | | | | | | | | | - Giovanni Montini
- Pediatric NephrologyDialysis and Transplant UnitFondazione Ca'Granda, IRCCS Policlinico di MilanoMilanoItaly
- Giuliana and Bernardo Caprotti Chair of PediatricsDepartment of Clinical Sciences and Community HealthUniversity of MilanoMilanoItaly
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Altuntas N, Alan B. Midstream Clean-Catch Urine Culture Obtained by Stimulation Technique versus Catheter Specimen Urine Culture for Urinary Tract Infections in Newborns: A Paired Comparison of Urine Collection Methods. Med Princ Pract 2020; 29:326-331. [PMID: 31665720 PMCID: PMC7445695 DOI: 10.1159/000504443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/30/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The group of Herreros Fernández developed a new, safe, quick, and successful technique for collecting midstream clean-catch urine(MS-CCU) in newborns based on bladder stimulation and lumbar paravertebral massage maneuvers. The purpose of this study was to compare the contamination rates of catheter specimen urine (CSU) and MS-CCU by a lumbar/sacral stimulation technique in newborns. MATERIALS AND METHODS Full-term newborns ranging in age from 2 to 28 days who needed an investigation for a presumed urinary tract infection (UTI) were included in the study. Two samples, MS-CCU by lumbar/sacral stimulation technique and CSU, were collected consecutively for each patient. Suitable samples were obtained from 90 patients. RESULTS The contamination rate in MS-CCU cultures (n = 24/90, 26.66%) was higher than in CSU cultures (n = 9/90, 10%), and the difference was statistically significant (p = 0.039). Thirteen patients had UTI according to both samples (14.14%). In urine analysis, while there was no statistically significant difference in bacteriuria (p = 0.61) and nitrite positivity (p = 0.14) between patients with and without UTI, pyuria (p = 0.01) and leukocyte esterase positivity (p = 0.01) were higher in patients with UTI, and the difference was statistically significant. CONCLUSION The contamination rate in MS-CCU cultures was two and a half times greater than in the CSU culture samples. Thus, MS-CCU cannot replace the catheter for the diagnosis of UTI.
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Affiliation(s)
- Nilgun Altuntas
- Division of Neonatology, Department of Pediatrics, Ankara Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey,
| | - Basak Alan
- Department of Pediatrics, Ankara Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey
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Jacob R, John-Denny B, Donaldson K, White B, Outhred A, McCaskill ME. Educational intervention does not reduce non-invasive urine contamination rates in children presenting to the emergency department. J Paediatr Child Health 2020; 56:142-147. [PMID: 31216105 DOI: 10.1111/jpc.14542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/18/2019] [Accepted: 05/30/2019] [Indexed: 01/05/2023]
Abstract
AIM Urinary tract infection is common in children with high contamination rates with non-invasive urine sampling (NIU). Our aims were to evaluate an educational tool for decreasing contamination rates and find factors associated with contamination. METHODS This was a prospective cohort interventional study with a review of microbiology data and medical records of all NIU specimens collected at a large tertiary children's emergency department (ED) over a 1-year period. The intervention was the provision of a urine collection kit and educational pamphlet and education of staff. NIU contamination was calculated for 6 months pre-intervention and 6 months post-intervention. The association of factors with NIU contamination was evaluated for all cohorts (age, gender, presence of diarrhoea, season, time of day, time to incubation and activity of the ED). RESULTS A total of 2104 NIU samples were included (median age 3 years, 52% females). There was no difference between periods in contamination rates (29.2% and 31.2%, respectively, P = 0.322). Collectively, high monthly activity of the department, age and female gender were associated with contamination. The highest contamination rates were among children aged 0-3 months and 12 years and older (38.1 and 48.9%, respectively). CONCLUSIONS The urine collection kit and educational tool did not decrease NIU contamination rates in our ED. Contamination rates were correlated with the monthly activity of our department and female gender and were noticeably high among infants and adolescents. Given the high prevalence of urinary tract infection among these age groups, measures should be taken to reassess indications and methods for urine collection.
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Affiliation(s)
- Ron Jacob
- Emergency Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Blessy John-Denny
- Emergency Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Katherine Donaldson
- Emergency Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Brent White
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Alexander Outhred
- Emergency Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Microbiology Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Mary E McCaskill
- Emergency Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Evaluation of bladder stimulation as a non-invasive technique for urine collection to diagnose urinary tract infection in infants under 6 months: a randomized multicenter study ("EE-Sti.Ve.N"). Trials 2019; 20:783. [PMID: 31881992 PMCID: PMC6935056 DOI: 10.1186/s13063-019-3914-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background Febrile urinary tract infection (UTI) is common in infants and needs to be diagnosed quickly. However, the symptoms are non-specific, and diagnosis can only be confirmed after high quality urinalysis. The American Academy of Pediatrics recommends suprapubic aspiration (1–9% contamination) and urinary catheterization (8–14% contamination) for urine collection but both these procedures are invasive. Recent studies have shown a new non-invasive method of collecting urine, bladder stimulation, to be quick and safe. However, few data about bacterial contamination rates have been published for this technique. We hypothesize that the contamination rate of urine collection by bladder stimulation to diagnose febrile UTI in infants under 6 months is equivalent to that of urinary catheterization. Methods/design This trial aims to assess equivalence in terms of bacterial contamination of urinary samples collected by urinary catheterization and bladder stimulation to diagnose UTI. Seven hundred seventy infants under 6 months presenting with unexplained fever in one of four Pediatric Emergency Departments in France will be enrolled. Each child will be randomized into a bladder stimulation or urinary catheterization group. The primary endpoints will be the validity of the urine sample assessed by the presence of contamination on bacterial culture. Conclusion A high recruitment rate is achievable due to the high prevalence of suspected UTIs in infants. The medical risk is the same as that for routine clinical care as we analyze patients with isolated fever. If our hypothesis holds true and the rate of urine contamination collected by bladder stimulation is acceptable, the infants included in the study will have benefited from a non-invasive and reliable means of collecting urine. Trial registration ClinicalTrials.gov, NCT03801213. Registered on 11 January 2019.
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Trottier ED, Doré-Bergeron MJ, Chauvin-Kimoff L, Baerg K, Ali S. La gestion de la douleur et de l’anxiété chez les enfants lors de brèves interventions diagnostiques et thérapeutiques. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
RésuméLes interventions médicales courantes utilisées pour évaluer et traiter les patients peuvent causer une douleur et une anxiété marquées. Les cliniciens devraient adopter une approche de base pour limiter la douleur et l’anxiété chez les enfants, notamment à l’égard des interventions diagnostiques et thérapeutiques fréquentes. Le présent document de principes est axé sur les nourrissons, les enfants et les adolescents qui subissent des interventions médicales courantes mineures, mais douloureuses. Il n’aborde pas les soins prodigués à l’unité de soins intensifs néonatale. Les auteurs examinent des stratégies simples et fondées sur des données probantes pour gérer la douleur et l’anxiété et donnent des conseils pour en faire un volet essentiel de la pratique clinique. Les professionnels de la santé sont invités à utiliser des façons de procéder peu invasives et, lorsque les interventions douloureuses sont inévitables, à combiner des stratégies simples de réduction de la douleur et de l’anxiété pour améliorer l’expérience du patient, du parent et du professionnel de la santé. Les administrateurs de la santé sont encouragés à créer des politiques pour leurs établissements, à améliorer la formation et l’accès aux lignes directrices, à créer des environnements propices aux enfants et aux adolescents, à s’assurer de la disponibilité du personnel, de l’équipement et des agents pharmacologiques appropriés et à effectuer des contrôles de qualité pour garantir une gestion de la douleur optimale.
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Affiliation(s)
- Evelyne D Trottier
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la pédiatrie communautaire, section de la médecine d’urgence pédiatrique, Ottawa (Ontario)
| | - Marie-Joëlle Doré-Bergeron
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la pédiatrie communautaire, section de la médecine d’urgence pédiatrique, Ottawa (Ontario)
| | - Laurel Chauvin-Kimoff
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la pédiatrie communautaire, section de la médecine d’urgence pédiatrique, Ottawa (Ontario)
| | - Krista Baerg
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la pédiatrie communautaire, section de la médecine d’urgence pédiatrique, Ottawa (Ontario)
| | - Samina Ali
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la pédiatrie communautaire, section de la médecine d’urgence pédiatrique, Ottawa (Ontario)
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Trottier ED, Doré-Bergeron MJ, Chauvin-Kimoff L, Baerg K, Ali S. Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures. Paediatr Child Health 2019; 24:509-535. [PMID: 31844394 PMCID: PMC6901171 DOI: 10.1093/pch/pxz026] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/21/2019] [Indexed: 12/17/2022] Open
Abstract
Common medical procedures to assess and treat patients can cause significant pain and distress. Clinicians should have a basic approach for minimizing pain and distress in children, particularly for frequently used diagnostic and therapeutic procedures. This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures. Simple, evidence-based strategies for managing pain and distress are reviewed, with guidance for integrating them into clinical practice as an essential part of health care. Health professionals are encouraged to use minimally invasive approaches and, when painful procedures are unavoidable, to combine simple pain and distress-minimizing strategies to improve the patient, parent, and health care provider experience. Health administrators are encouraged to create institutional policies, improve education and access to guidelines, create child- and youth-friendly environments, ensure availability of appropriate staff, equipment and pharmacological agents, and perform quality audits to ensure pain management is optimal.
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Affiliation(s)
- Evelyne D Trottier
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Marie-Joëlle Doré-Bergeron
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Laurel Chauvin-Kimoff
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Krista Baerg
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Samina Ali
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
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Stephanos K, Bragg AF. Pediatric Genitourinary Infections and Other Considerations. Emerg Med Clin North Am 2019; 37:739-754. [PMID: 31563205 DOI: 10.1016/j.emc.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pediatric patients pose a unique host of challenges to the emergency provider across all complaints and ages, but this is particularly notable in the genitourinary (GU) system. The pediatric GU system is different from that of the adult in its etiology of symptoms, complications, and treatments. Based on age, there are variations in the anatomy. These differences result in symptoms and diagnoses that must be managed differently. Although in many respects management is similar to GU emergency conditions in adults, there are, occasionally subtle, differences between the care of children and adults, which can greatly impact outcomes.
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Affiliation(s)
- Kathleen Stephanos
- Department of Emergency Medicine, University of Rochester, 601 Elmwood Avenue Box 655, Rochester, NY 14642, USA.
| | - Andrew F Bragg
- Department of Pediatrics, University of Rochester, 601 Elmwood Avenue Box 655, Rochester, NY 14642, USA
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Pain experienced by infants and toddlers at urine collection bag removal: A randomized, controlled, clinical trial. Int J Nurs Stud 2019; 95:1-6. [PMID: 30981953 DOI: 10.1016/j.ijnurstu.2019.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND In pre-continent children, collection bags are frequently used as a first-line option to obtain a urine specimen. This practice, acknowledged by several guidelines for the step of UTI screening, is driven by a perception of the technique as being more convenient and less painful. However, our own experience led us to consider bag removal as a painful experience. OBJECTIVE Our aim was to determine whether the use of an oleo-calcareous liniment to aid bag removal reduced the acute pain expressed by young children. METHODS This prospective, randomized, controlled, single blind study was carried out in two emergency pediatrics departments. Pre-continent children aged 0-36 months admitted with an indication for urine testing were eligible for the study. Urine for dipstick test screening was obtained using a collection bag. At micturition, the patients were randomized into bag removal with (intervention group) or without (control group) liniment. Bag removal was recorded on video in such a manner as to permit independent assessments of pain by two evaluators blinded to group allocation. Pain was assessed using the FLACC scale. FINDINGS 135 patients were analyzed: 70 in the intervention group and 65 in the control group. The median FLACC scores [interquartile range] for the intervention and control groups, respectively 4.0 [2.0-7.0] and 4.0 [3.0-7.0], did not differ significantly (p = 0.5). A FLACC score ≥4 was obtained for 56% of the patients and a score ≥7 for 28%. CONCLUSION Removal of urine collection bags caused moderate to severe pain in half of the children included. The use of an oleo-calcareous liniment did not reduce this induced pain.
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Simrén Y, Valdimarsson S, Stokland E, Lagerstrand KM, Sixt R, Hansson S. Renal swelling indicates renal damage in infants with their first urinary tract infection. Acta Paediatr 2018; 107:2004-2010. [PMID: 29972698 DOI: 10.1111/apa.14489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/21/2018] [Accepted: 07/02/2018] [Indexed: 11/29/2022]
Abstract
AIM We used ultrasound to evaluate renal swelling as a predictor of acute and permanent renal damage in infants with their first urinary tract infection (UTI). METHODS The cohort at the Queen Silvia Children's Hospital, Gothenburg, Sweden, comprised 101 infants with their first UTI at a mean age of 3.9 ± 3.0 months. Acute and follow-up ultrasounds were carried out a few days and one month after treatment started, and a 99m technetium dimercaptosuccinic acid (DMSA) scan was carried out after one month and after a year if the first scan was abnormal. RESULTS The acute ultrasounds showed that renal length and volume, calculated as standard deviation scores (SDS), were 1.39 ± 1.43 SDS and 1.30 ± 1.08 SDS. We found that 52% of the one-month DMSA scans and 25% of the one-year DMSA scans were abnormal. Renal length (p = 0.0026) and initial volume (p = 0.0005) on the ultrasound predicted acute renal damage at the one-month DMSA scan and initial renal length (p = 0.030) predicted permanent renal damage at the one-year DMSA scan. CONCLUSION Renal swelling was associated with renal damage. Although the diagnostic performance compared with the DMSA scan was weak, renal swelling may help clinicians to make decisions about further investigations and follow-ups of infants with UTIs.
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Affiliation(s)
- Y Simrén
- Department of Radiology; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - S Valdimarsson
- Department of Paediatrics; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E Stokland
- Department of Radiology; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - K M Lagerstrand
- Department of Radiation Physics; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - R Sixt
- Department of Paediatric Clinical Physiology; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - S Hansson
- Department of Paediatrics; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Ray S, Forbes O. Quick-Wee is an effective technique for urine collection in infants. Arch Dis Child Educ Pract Ed 2018; 103:280-281. [PMID: 28993431 DOI: 10.1136/archdischild-2017-313619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Satyajit Ray
- Department of paediatrics, Royal Hospital for Children, Glasgow, UK
| | - Owen Forbes
- Department of paediatrics, Royal Hospital for Children, Glasgow, UK
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Herreros ML, Tagarro A, García-Pose A, Sánchez A, Cañete A, Gili P. Performing a urine dipstick test with a clean-catch urine sample is an accurate screening method for urinary tract infections in young infants. Acta Paediatr 2018; 107:145-150. [PMID: 28940750 DOI: 10.1111/apa.14090] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/20/2017] [Accepted: 09/20/2017] [Indexed: 12/15/2022]
Abstract
AIM This study evaluated using urine dipstick tests with the clean-catch method to screen for urinary tract infection (UTI) in febrile infants under 90 days of age. METHODS We carried out a comparative diagnostic accuracy study of infants under 90 days old, who were studied for unexplained fever without any source, in the emergency room of a hospital in Madrid from January 2011 to January 2013. We obtained matched samples of urine using two different methods: a clean-catch, standardised stimulation technique and catheterisation collection. The results of the leucocyte esterase test and nitrite test were compared with their urine cultures. RESULTS We obtained 60 pairs of matched samples. A combined analysis of leukocyte esterase and, or, nitrites yielded a sensitivity of 86% and a specificity of 80% for the diagnosis of UTIs in clean-catch samples. The sensitivity of leukocyte esterase and, or, nitrites in samples obtained by catheterisation were not statistically different to the clean-catch samples (p = 0.592). CONCLUSION Performing urine dipstick tests using urine samples obtained by the clean-catch method was an accurate screening test for diagnosing UTIs in febrile infants of less than 90 days old. This provided a good alternative to bladder catheterisation when screening for UTIs.
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Affiliation(s)
- María Luisa Herreros
- Department of Pediatrics; Infanta Sofía University Hospital; San Sebastián de los Reyes, Madrid Spain
- Faculty of Health Sciences; European University; Madrid Spain
| | - Alfredo Tagarro
- Department of Pediatrics; Infanta Sofía University Hospital; San Sebastián de los Reyes, Madrid Spain
- Faculty of Health Sciences; European University; Madrid Spain
| | - Araceli García-Pose
- Department of Pediatrics; Infanta Sofía University Hospital; San Sebastián de los Reyes, Madrid Spain
| | - Aida Sánchez
- Department of Microbiology; Infanta Sofía University Hospital; San Sebastián de los Reyes, Madrid Spain
| | - Alfonso Cañete
- Department of Pediatrics; Infanta Sofía University Hospital; San Sebastián de los Reyes, Madrid Spain
- Faculty of Health Sciences; European University; Madrid Spain
| | - Pablo Gili
- Faculty of Health Sciences; European University; Madrid Spain
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Valdimarsson S, Jodal U, Barregård L, Hansson S. Urine neutrophil gelatinase-associated lipocalin and other biomarkers in infants with urinary tract infection and in febrile controls. Pediatr Nephrol 2017; 32:2079-2087. [PMID: 28756475 DOI: 10.1007/s00467-017-3709-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Urine biomarkers are commonly used in the evaluation of acute kidney injury, and are gaining attention as tools for studying urinary tract infections (UTIs). We analyzed neutrophil gelatinase-associated lipocalin (NGAL) and seven other urine biomarkers to evaluate their usefulness in the diagnosis of UTI in infants. METHODS Eight urine biomarkers were analyzed in 108 infants with UTI. Controls were 64 febrile children without UTI and 13 healthy children. Logistic regression and construction of receiver operating characteristic (ROC) curves were performed for UTI patients versus febrile controls for all biomarkers. RESULTS The best biomarkers to differentiate between UTI and febrile controls were NGAL and interleukin 8 (IL8). Urine NGAL in absolute concentration and adjusted for creatinine had a sensitivity of 93% and 96% and a specificity of 95% and 100% for diagnosing UTI, with a cut-off concentration of 38 ng/mL and 233 ng/mg respectively. CONCLUSIONS Urine biomarkers, particularly NGAL, can aid in the diagnosis of UTI among febrile infants. The results suggest that in infants with fever and high NGAL, UTI is most likely, whereas in infants with fever and low NGAL, other causes of fever should be looked for.
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Affiliation(s)
- Sindri Valdimarsson
- Department of Pediatrics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg, Sweden.
- The Queen Silvia Children's Hospital, 416 85, Gothenburg, Sweden.
| | - Ulf Jodal
- Department of Pediatrics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lars Barregård
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Sverker Hansson
- Department of Pediatrics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg, Sweden
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39
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Kaufman J, Tosif S, Duke T. Voiding stimulation methods for collecting urine from young pre-continent children. Paediatr Int Child Health 2017; 37:298-299. [PMID: 29157180 DOI: 10.1080/20469047.2017.1399650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jonathan Kaufman
- a Royal Children's Hospital , Melbourne , Australia.,b Murdoch Children's Research Institute , Melbourne , Australia.,c Department of Paediatrics , University of Melbourne , Melbourne , Australia
| | - Shidan Tosif
- a Royal Children's Hospital , Melbourne , Australia.,b Murdoch Children's Research Institute , Melbourne , Australia.,c Department of Paediatrics , University of Melbourne , Melbourne , Australia.,d Centre for International Child Health , University of Melbourne and Royal Children's Hospital , Melbourne , Australia
| | - Trevor Duke
- a Royal Children's Hospital , Melbourne , Australia.,b Murdoch Children's Research Institute , Melbourne , Australia.,c Department of Paediatrics , University of Melbourne , Melbourne , Australia.,d Centre for International Child Health , University of Melbourne and Royal Children's Hospital , Melbourne , Australia
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40
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Tosif S, Kaufman J, Fitzpatrick P, Hopper SM, Hoq M, Donath S, Babl FE. Clean catch urine collection: Time taken and diagnostic implication. A prospective observational study. J Paediatr Child Health 2017; 53:970-975. [PMID: 28618045 DOI: 10.1111/jpc.13595] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/22/2017] [Accepted: 04/08/2017] [Indexed: 12/01/2022]
Abstract
AIM Clean catch urine (CCU) collection is commonly used in pre-continent children. CCU can be time-consuming and specimens may be contaminated. Our aim was to determine the time taken for CCU attempts and to describe the success of this method in diagnosing or excluding urinary tract infection. METHODS Prospective observational study of CCU in pre-continent children aged 2-48 months in the emergency department. Time taken until urine collection, 'successful' (voided and caught), 'missed' (voided not caught) or the procedure 'stopped', were recorded and urine culture results analysed. RESULTS Two hundred and seventeen children (131 (60%) male) were enrolled. There were a total of 247 attempts at CCU. For the first attempt, the median collecting time was 30.5 min (interquartile range (IQR) 11-66). Outcome was 'successful' in 64% (95% confidence intervals (CI) 58-70%), 'missed' in 16% (95% CI 11-20%) and 'stopped' in 20% (95% CI 15-26%). Median time if 'successful' was 25 min (IQR 7-46.5), 'missed' 27 min (IQR 11.6-59) and 71 min (IQR 42.5-93) when 'stopped'. One hundred and sixty children had successful CCU collection, 129 were sent for culture. Fifty of 129 (39%) cultures were contaminated. If all urine specimens caught were sent for culture, the estimated yield of an uncontaminated urine specimen was 45%. Contamination was not related to time taken for CCU. CONCLUSIONS CCU is time-consuming, frequently unsuccessful and contaminated, resulting in a low overall diagnostic yield. Clinicians could expect a 45% chance of obtaining a definitive urine sample from this method overall.
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Affiliation(s)
- Shidan Tosif
- Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Kaufman
- Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Patrick Fitzpatrick
- Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sandy M Hopper
- Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre Melbourne, Melbourne, Victoria, Australia
| | - Monsurul Hoq
- Clinical Epidemiology, and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Susan Donath
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology, and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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41
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Restrepo de Rovetto C. [Urinary tract infection: a prevalent problem in Pediatrics]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2017; 74:241-242. [PMID: 29382513 DOI: 10.1016/j.bmhimx.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 06/07/2023] Open
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42
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Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Donath SM, Bryant PA, Babl FE. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ 2017; 357:j1341. [PMID: 28389435 PMCID: PMC6284210 DOI: 10.1136/bmj.j1341] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective To determine if a simple stimulation method increases the rate of infant voiding for clean catch urine within five minutes.Design Randomised controlled trial.Setting Emergency department of a tertiary paediatric hospital, Australia.Participants 354 infants (aged 1-12 months) requiring urine sample collection as determined by the treating clinician. 10 infants were subsequently excluded.Interventions Infants were randomised to either gentle suprapubic cutaneous stimulation (n=174) using gauze soaked in cold fluid (the Quick-Wee method) or standard clean catch urine with no additional stimulation (n=170), for five minutes.Main outcome measures The primary outcome was voiding of urine within five minutes. Secondary outcomes were successful collection of a urine sample, contamination rate, and parental and clinician satisfaction with the method.Results The Quick-Wee method resulted in a significantly higher rate of voiding within five minutes compared with standard clean catch urine (31% v 12%, P<0.001), difference in proportions 19% favouring Quick-Wee (95% confidence interval for difference 11% to 28%). Quick-Wee had a higher rate of successful urine sample collection (30% v 9%, P<0.001) and greater parental and clinician satisfaction (median 2 v 3 on a 5 point Likert scale, P<0.001). The difference in contamination between Quick-Wee and standard clean catch urine was not significant (27% v 45%, P=0.29). The number needed to treat was 4.7 (95% confidence interval 3.4 to 7.7) to successfully collect one additional urine sample within five minutes using Quick-Wee compared with standard clean catch urine.Conclusions Quick-Wee is a simple cutaneous stimulation method that significantly increases the five minute voiding and success rate of clean catch urine collection.Trial registration Australian New Zealand Clinical Trials Registry ACTRN12615000754549.
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Affiliation(s)
- Jonathan Kaufman
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Fitzpatrick
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Shidan Tosif
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Penelope A Bryant
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Franz E Babl
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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