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Clean catch urine collection: Time taken and diagnostic implication. A prospective observational study
Shidan Tosif1,2,3, Jonathan Kaufman2,3,4, Patrick Fitzpatrick2,4
1Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
Insights
Clean catch urine (CCU) collection in children is time-consuming and often unsuccessful. This method yields a low diagnostic rate for urinary tract infections due to contamination and collection failures.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Microbiology
- Urology
Background:
- Clean catch urine (CCU) collection is a standard method for obtaining urine samples in pre-continent children.
- CCU procedures can be lengthy and may result in specimen contamination, impacting diagnostic accuracy.
Purpose of the Study:
- To evaluate the time required for CCU attempts in children.
- To assess the success rate of CCU in diagnosing or excluding urinary tract infections (UTIs).
Main Methods:
- A prospective observational study was conducted in an emergency department setting.
- Data collected included time to urine collection, success rates ('successful', 'missed', 'stopped'), and urine culture results for children aged 2-48 months.
Main Results:
- Out of 217 children and 247 attempts, the median collection time was 30.5 minutes.
- Successful collection occurred in 64% of attempts, with 39% of cultured specimens showing contamination.
- The overall estimated yield of an uncontaminated urine specimen was 45%.
Conclusions:
- CCU collection is inefficient, often unsuccessful, and prone to contamination, leading to a low diagnostic yield for UTIs.
- Clinicians can anticipate approximately a 45% probability of obtaining a definitive urine sample using the CCU method.
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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