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Urine culture from bag specimens in young children: are the risks too high?
F Al-Orifi1, D McGillivray, S Tange
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University, Quebec, Canada.
Insights
The noninvasive bag method for pediatric urine culture has significantly higher contamination rates than catheterization. This leads to increased risks of adverse clinical outcomes, including delayed diagnosis and unnecessary treatments.
Area of Science:
- Pediatric Medicine
- Clinical Microbiology
- Diagnostic Accuracy
Background:
- Urine culture is crucial for diagnosing urinary tract infections in young children.
- The clean-voided bag method is often preferred for its noninvasive nature.
- Concerns exist regarding the reliability and safety of bag-collected urine samples.
Purpose of the Study:
- To compare the contamination rates and associated adverse clinical outcomes of urine specimens collected via the bag method versus catheterization in children.
- To evaluate the overall risk-benefit profile of the bag urine culture technique.
Main Methods:
- A hospital-based cohort study included 7584 children aged 24 months or younger undergoing outpatient urine cultures.
- Medical records were reviewed for children with contaminated cultures who had repeat cultures within 7 days.
- Contamination rates for bag and catheter specimens were compared, along with subsequent clinical outcomes.
Main Results:
- Bag urine cultures exhibited significantly higher contamination rates (62.8%) compared to catheter specimens (9.1%).
- Contaminated bag urines led to various adverse clinical outcomes, including unnecessary recalls, delayed diagnosis, and unnecessary treatments.
- Adjusted odds ratios indicated substantially increased risks for adverse outcomes with the bag method, such as 4.9 for unnecessary recall and 15.6 for unnecessary prolonged treatment.
Conclusions:
- The clean-voided bag method for pediatric urine culture is associated with substantially higher contamination rates.
- The risks of adverse clinical outcomes stemming from contaminated bag urine cultures appear to outweigh the benefits of this noninvasive approach.
- Catheterization remains a more reliable method for obtaining uncontaminated urine samples in young children.
Objective:
To compare the risks of contaminated culture results and consequent adverse clinical outcomes in urine specimens obtained by "clean-voided" bag method versus catheterization.
Study Design:
Hospital-based cohort study of all children
Results:
Contamination rates were 62.8% and 9.1% (P <.001) in bag versus catheter specimens, respectively. Contamination rates of bag urine specimens collected in the emergency department and pediatric test center were 56.4% versus 69. 25%, respectively. Of the 3440 contaminated urines, 132 (1.7%) resulted in 1 or more adverse clinical outcomes. Adjusted odds ratios (and 95% CI) for these outcomes in bag versus catheter specimens were as follows: 4.9 (2.3 to 10.5) for unnecessary recall, infinite for delayed diagnosis and treatment, 4.8 (1.8 to 12.4) for unnecessary treatment, 15.6 (2.1 to 116.8) for unnecessary prolonged treatment, 4.1 (1.4 to 12.1) for unnecessary radiologic investigation, and 12.4 (1.6 to 95.5) for unnecessary hospital admission.
Conclusions:
The risks of the "noninvasive" bag urine culture appear to exceed its benefits.