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Lambert HJ, Coulthard MG. Urinary tract infection guidelines should address unique, specific questions and include analyses of primary data. Pediatr Nephrol 2024; 39:1679-1683. [PMID: 38231232 DOI: 10.1007/s00467-023-06255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Heather J Lambert
- Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Malcolm G Coulthard
- Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
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2
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Bahans C, Dallocchio A, Tran A, Dubos F, Soto B, Schoder G, Blanc P, Messager V, Demonchy D, Labrunie A, Garnier F, Guigonis V. The position during urine sample collection from young precontinent children through a bag does not limit contamination rates: Results from a randomized controlled trial: Does infant position influence quality of urine collection? Arch Pediatr 2022; 29:359-363. [PMID: 35513967 DOI: 10.1016/j.arcped.2022.03.007] [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: 12/07/2021] [Revised: 02/10/2022] [Accepted: 03/26/2022] [Indexed: 11/24/2022]
Abstract
AIM Despite its limitation, bag collection is still widely used for a preliminary urine screening test in non-toilet-trained children suspected of febrile urinary tract infection. A previous study conducted by our group raised the hypothesis that the absence of direct contact between urine and the perinea during urine collection could limit urine contamination by perineal flora. The aim of this study was to evaluate the impact of the patient's position during urine collection (upright standing position versus free position) on the rate of contaminated urine samples in non-toilet-trained children with suspected febrile urinary tract infection. METHODS This prospective, randomized, controlled study took place in seven pediatric emergency departments. Two groups were compared: the intervention group (infants held in an upright standing position during urination) and the control group (free position during urination). RESULTS Among the 800 pediatric patients randomized to the study, 124 had a urine culture, 60 in the intervention group and 64 in the control group. Among the 124 urine cultures, 12 (9.7%) were contaminated: eight (13.3%) in the intervention group and four (6.3%) in the control group (p = 0.1824). CONCLUSION The results show that the patient's position does not have a significant impact on the quality of urine samples collected by bag.
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Affiliation(s)
- C Bahans
- Département de pédiatrie, CHU de Limoges, 8 avenue Dominique Larrey, 87000 Limoges, France.
| | - A Dallocchio
- Département de pédiatrie, CHU de Limoges, 8 avenue Dominique Larrey, 87000 Limoges, France
| | - A Tran
- Urgences pédiatriques, Hôpitaux pédiatriques de Nice CHU Lenval, 57 avenue de la Californie, 06200 Nice, France
| | - F Dubos
- CHU Lille, Urgences pédiatriques et maladies infectieuses, 2 avenue Oscar Lambret, 59000 Lille, France
| | - B Soto
- Service de Pédiatrie, Centre hospitalier de Troyes, 101 avenue Anatole France, 10000 Troyes, France
| | - G Schoder
- Service de pédiatrie, CHR Metz-Thionville, 1 allée du château, 57100 Metz, France
| | - P Blanc
- Service de pédiatrie, CHI de Poissy Saint Germain en Laye, 20 rue Armagis, 78100 Saint Germain en Laye, France
| | - V Messager
- Département de pédiatrie, CHU de Limoges, 8 avenue Dominique Larrey, 87000 Limoges, France
| | - D Demonchy
- Urgences pédiatriques, Hôpitaux pédiatriques de Nice CHU Lenval, 57 avenue de la Californie, 06200 Nice, France
| | - A Labrunie
- Centre d'épidémiologie, de biostatistique et de méthodologie de la recherche (CEBIMER), CHU de Limoges, 2 avenue Martin Luther King, 87000 Limoges, France
| | - F Garnier
- Laboratoire de bactériologie-Virologie-Hygiène, CHU de Limoges, 2 avenue Martin Luther King, 87000 Limoges, France
| | - V Guigonis
- Département de pédiatrie, CHU de Limoges, 8 avenue Dominique Larrey, 87000 Limoges, France
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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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Forrester C, Mahomed A. Design of a novel midstream fluid waste sample collection device for patients. J Med Eng Technol 2021; 45:664-671. [PMID: 34463586 DOI: 10.1080/03091902.2021.1955031] [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: 01/11/2023]
Abstract
Reducing the contamination rates in mid-stream urine samples is a challenge. A novel design for a mid-stream urine sample collection device, which uses a novel mechanism to separate the mid-stream flow from the fore-stream and end-stream flows based on flow speed, is presented. The device, supplied in two parts, is designed to be clipped to a toilet and used in a seated position, which improves ease of use for disabled patients. As there is no mixing of the flow types during use, it is hypothesised that contamination rates should be lower than many competing designs. The all-polymer design is easy to use by both men and women, due to the addition of a form-fitting funnel and is designed to collect samples directly into containers of the same standard currently issued, allowing easy and hygienic collection. Due to its complex shape, the main body of the device is produced by a non-conventional injection moulding process. The holder can be produced using standard injection moulding technology. The two parts are designed to be assembled together by the user by means of a simple interference fit, which removes the cost of assembly altogether.
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Affiliation(s)
- Christopher Forrester
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Aziza Mahomed
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
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Leung AKC, Wong AHC, Leung AAM, Hon KL. Urinary Tract Infection in Children. ACTA ACUST UNITED AC 2020; 13:2-18. [PMID: 30592257 PMCID: PMC6751349 DOI: 10.2174/1872213x13666181228154940] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urinary Tract Infection (UTI) is a common infection in children. Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition. OBJECTIVE To provide an update on the evaluation, diagnosis, and treatment of urinary tract infection in children. METHODS A PubMed search was completed in clinical queries using the key terms "urinary tract infection", "pyelonephritis" OR "cystitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature and the pediatric age group. Patents were searched using the key terms "urinary tract infection" "pyelonephritis" OR "cystitis" from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com. RESULTS Escherichia coli accounts for 80 to 90% of UTI in children. The symptoms and signs are nonspecific throughout infancy. Unexplained fever is the most common symptom of UTI during the first two years of life. After the second year of life, symptoms and signs of pyelonephritis include fever, chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include suprapubic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children to radiation. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcome. The choice of antibiotics should take into consideration local data on antibiotic resistance patterns. Recent patents related to the management of UTI are discussed. CONCLUSION Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI. Parenteral antibiotic therapy is recommended for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication. A combination of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin can be used in those situations. Routine antimicrobial prophylaxis is rarely justified, but continuous antimicrobial prophylaxis should be considered for children with frequent febrile UTI.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Amy A M Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
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Coulthard MG. Defining urinary tract infection by bacterial colony counts: a case for 100,000 colonies/ml as the best threshold. Pediatr Nephrol 2019; 34:1639-1649. [PMID: 31254111 DOI: 10.1007/s00467-019-04283-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 05/19/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Malcolm G Coulthard
- Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
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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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