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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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Clinical Evaluation of a Novel Urine Collection Kit Using Filter Paper in Neonates: An Observational Study. CHILDREN-BASEL 2021; 8:children8070561. [PMID: 34209909 PMCID: PMC8304071 DOI: 10.3390/children8070561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022]
Abstract
Urine bags are commonly used to collect urine samples from neonates. However, the sample can be contaminated by stool, or detachment of the bag due to body movement can lead to failure of the collection. A qualitative urine collection kit containing ten filter papers of 3.2 mm diameter was developed and clinically verified among 138 neonates. During a single diaper change (approximately 3 h), the rate of urine collection was calculated. Urine collection was considered to be successful if any filter paper in the urine collection sheet turned from blue to white. Of the 127 neonates who passed urine, 122 had a change in the filter paper. The urine collection rate was 96%, with changes in all 10 filter papers observed in 98 neonates (80%). Urine collection rate was not influenced by sex (p = 1.00), age at collection (p = 0.72), preterm birth (p = 1.00), low birth weight (p = 0.92), or fecal contamination (p = 1.00). The incidence of dermatitis was not higher than in the group in which urine bags were used (urine collection kit: 2/68 [3%]; urine bag: 5/68 [7%]; p = 0.44). Novel urine collection kits using filter paper can collect samples from neonates safely and with a high probability of success.
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Park JS, Byun YH, Lee JY, Lee JS, Ryu JM, Choi SJ. Clinical utility of procalcitonin in febrile infants younger than 3 months of age visiting a pediatric emergency room: a retrospective single-center study. BMC Pediatr 2021; 21:109. [PMID: 33663442 PMCID: PMC7931518 DOI: 10.1186/s12887-021-02568-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fever in infants under 90 days of age is highly likely to be caused by a severe bacterial infection (SBI) and it accounts for a large number of patients visiting the pediatric emergency room. In order to predict the bacterial infection and reduce unnecessary treatment, the classic classification system is based on white blood cell (WBC) count, urinalysis, and x-ray, and it is modified and applied at each center by incorporating recently studied biomarkers such as c-reactive protein (CRP) or procalcitonin (PCT). This study analyzed the usefulness of PCT in predicting SBI when applied along with the existing classification system, including CRP, among infants less than 90 days old who visited with a fever at a single institution pediatric emergency center. METHODS We retrospectively reviewed the medical records of patients younger than 3 months of age who presented with fever at the Seoul Asan Medical Center pediatric emergency room between July 2017 and October 2018. RESULTS A total of 317 patients were analyzed, and 61 were diagnosed with SBI, among which urinary tract infection (UTI) accounted for the largest proportion (55/61, 90.2%). There were differences in WBC, neutrophil proportion, CRP, and PCT between the SBI group and the non-SBI group, and the AUC values of WBC, CRP, and PCT were 0.651, 0.804, and 0.746, respectively. When using the cut-off values of CRP and PCTs as 2.0 mg/dL and 0.3 ng/mL, respectively, the sensitivity and specificity for SBI were 49.2/89.5, and 54.1/87.5, respectively. WBC, CRP, and PCT were statistically significant for predicting SBI in multivariate analysis (odds ratios 1.066, 1.377, and 1.291, respectively). When the subjects were classified using the existing classification criteria, WBC and CRP, the positive predictive value (PPV) and negative predictive value (NPV) were 29.3 and 88.7%, respectively, and when PCT was added, the PPV and NPV were 30.7 and 92%, respectively, both increased. CONCLUSION PCT is useful for predicting SBI in children aged 3 months or less who visit the emergency room with a fever. It is useful as a single biomarker, and when used in conjunction with classic biomarkers, its diagnostic accuracy is further increased.
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Affiliation(s)
- Jun-Sung Park
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young-Hoon Byun
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jeong-Yong Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jong Seung Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Min Ryu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Jun Choi
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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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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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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Cousin E, Ryckewaert A, de Jorna Lecouvey C, Arnaud AP. Urine collection methods used for non-toilet-trained children in pediatric emergency departments in France: A medical practice analysis. Arch Pediatr 2018; 26:16-20. [PMID: 30554850 DOI: 10.1016/j.arcped.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/28/2018] [Accepted: 11/10/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Since April 2015, the French Society of Pediatrics has encouraged suprapubic aspiration (SA) and urethral catheterization (UC) for urine collection in non-toilet-trained children suspected of having urinary tract infections (UTIs) and has tried to reduce the use of urine bag (UB). OBJECTIVE To analyze the medical practices concerning urine collection methods used for non-toilet-trained children in pediatric emergency departments in France. METHODS We conducted a descriptive medical practice study in October 2017. All members of the French Society of Pediatric Nephrology received two questionnaires about urine collection methods used for non-toilet-trained children, distinguishing between male and female patients, and about the corresponding analgesic protocols used in their pediatric emergency departments. RESULTS In total, 26 centers completed questionnaires concerning female patients. UC was performed in cases of fever associated with urinary tract malformations in 14 of 26 centers (54%). UB was used in cases of fever of unknown origin lasting for more than 48h in 17 of 26 centers (65%), in cases of fever associated with UTI symptoms in 14 of 26 centers (54%), and in cases of fever in infants under 3 months of age in 16 of 26 centers (61%). The questionnaires concerning male patients were completed by 30 centers. UB was the initially used urine collection method in all situations with, respectively, 22 of 30 (73%), 27 of 30 (90%), 23 of 30 (77%), and 22 of 30 (73%) centers. The analgesic protocol for urine collection is not well established in France. CONCLUSION UC for urine collection in pediatric emergency departments in France is underused despite the national recommendations and the greater diagnostic power of this method compared with UB.
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Affiliation(s)
- E Cousin
- Service de pédiatrie, université de Rennes, CHU de Rennes, hôpital sud, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France.
| | - A Ryckewaert
- Service de pédiatrie, université de Rennes, CHU de Rennes, hôpital sud, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France
| | - C de Jorna Lecouvey
- Service de pédiatrie, université de Rennes, CHU de Rennes, hôpital sud, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France; Service de pédiatrie, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - A P Arnaud
- UMR_A 1341, UMR_S 1241, Inra, Inserm, institut NUMECAN, université de Rennes, 2 rue Henri-le-Guilloux, 35000 Rennes, France; Service de chirurgie pédiatrique, université de Rennes, CHU de Rennes, hôpital Sud16, boulevard de Bulgarie, , 35203 Rennes cedex 2, France
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Yamasaki Y, Uemura O, Nagai T, Yamakawa S, Hibi Y, Yamamoto M, Nakano M, Kasahara K, Bo Z. Pitfalls of diagnosing urinary tract infection in infants and young children. Pediatr Int 2017; 59:786-792. [PMID: 28390079 DOI: 10.1111/ped.13292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to examine the sensitivity and specificity of pyuria-based diagnosis of urinary tract infection (UTI) in urine collected by transurethral catheterization, and the reliability of diagnosis of pyuria in urine collected in a perineal bag. The gold standard for UTI diagnosis is significant colony counts of a single organism in urine obtained in a sterile manner. METHODS We enrolled 301 patients who underwent medical examination at the present hospital for possible UTI between January 2005 and December 2009. We collected 438 urine samples by transurethral catheterization. We investigated the accuracy of pyuria-based diagnosis of UTI using transurethral catheterization urine specimens, and the reliability of diagnosis of pyuria using bag-collected urine specimens. RESULTS The false-negative rate of UTI diagnosis based on pyuria in transurethral catheterization urine sediments was 9.0%; there was no significant difference in the false-negative rate of UTI diagnosis between boys and girls. Approximately 28% of pyuria-positive bag-collected urine specimens were pyuria negative on transurethral catheterization; this rate was significantly higher in girls than in boys (56.7% vs. 8.9%, P < 0.0001). CONCLUSIONS The absence of pyuria in transurethral catheterization urine sediments does not rule out UTI. Pyuria in bag-collected urine specimens frequently consists of urine leukocytes from external genitalia as well as from the urinary tract.
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Affiliation(s)
- Yasuhito Yamasaki
- Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Osamu Uemura
- Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Takuhito Nagai
- Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Satoshi Yamakawa
- Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Yoshiko Hibi
- Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Masaki Yamamoto
- Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Masaru Nakano
- Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Katsuaki Kasahara
- Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Zhang Bo
- Department of Biochemistry, Fukuoka University School of Medicine, Jonanku, Fukuoka, Japan
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Yusuf E, Van Herendael B, van Schaeren J. Performance of urinalysis tests and their ability in predicting results of urine cultures: a comparison between automated test strip analyser and flow cytometry in various subpopulations and types of samples. J Clin Pathol 2016; 70:631-636. [DOI: 10.1136/jclinpath-2016-204108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/18/2016] [Accepted: 11/27/2016] [Indexed: 11/04/2022]
Abstract
AimsResults of urinalysis are available earlier than urine culture results. If urinalysis can predict results of culture, early decision can be made on treatment and whether urine samples should be cultured. This study sought to compare the performance of urinalysis tests by automated test strip analyser (nitrite and leucocyte esterase) with flow cytometry (bacteria and white cell count) in different subpopulations and types of samples.MethodsConsecutive urine samples (n=2351) from a population with a median age of 45 years, 37.2% men, were tested. Sensitivity, specificity, positive predictive value and negative predictive value (NPV) of the tests were calculated using contingency tables. The gold standard was positive urine culture with cut-off >105 CFU/mL.Results14% of the cultures were positive (95.6% monomicrobial, 74.7% Enterobacteriaceae). Overall, nitrite test was the most specific (98.7%) but the least sensitive (43.2%). Bacteria count was the most sensitive (91.7%) and highly specific (87.5%). In infants <24 months, the sensitivity of bacteria count was reduced (86.1%), but specificity was high (95.9%). The specificity of nitrite was reduced in urine from the in-and-out procedure (81.9%). The sensitivity of bacteria count was reduced in bag specimens urine (83.3%) and in urine from indwelling catheter (84.7%). All tests showed a high NPV. The NPV of the combined flow cytometry tests was higher than those of automated test strip analyser (99.1% vs 97.4%).ConclusionsOverall, the performance of urinalysis is excellent. Flow cytometry tests performed better than automated test strip analyser in ruling out urine to be cultured.
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