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Urine collection methods for infants under 3 months of age in clinical practice
María Luisa Herreros1,2, Pablo Gili3, Rut Del Valle4,5
1Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain. marisaherrerosfernandez@gmail.com.
Insights
Clean-catch urine stimulation technique (CCUST) is effective for diagnosing urinary tract infections (UTI) in infants under 3 months. This non-invasive method shows comparable results to urethral catheterization (UC) with acceptable contamination rates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Urology
Background:
- Accurate diagnosis of urinary tract infections (UTI) in infants is crucial.
- Uncontaminated urine cultures are essential for definitive UTI diagnosis.
- Urine collection methods in precontinent children, particularly infants, remain a subject of debate.
Purpose of the Study:
- To describe and compare urine collection methods for culture in infants under 3 months.
- To evaluate the results and contamination rates associated with different urine collection techniques.
- To determine the most effective and reliable method for UTI diagnosis in this age group.
Main Methods:
- Retrospective observational cohort study of 721 urine cultures from infants <3 months.
- Comparison of urine cultures based on collection technique: clean-catch urine stimulation technique (CCUST), urethral catheterization (UC), and urine bag (UB).
- Analysis of positive culture rates and contamination rates for each method.
Main Results:
- CCUST was the most frequent method (82.1%), followed by UC (10.7%) and UB (7.2%).
- Positive culture rates were 11.7% for CCUST and 28.6% for UC (p<0.001).
- Contamination rates differed significantly between UB (23.1%) and UC (5.2%) (p=0.007), with CCUST at 13.7%.
Conclusions:
- CCUST is the predominant urine collection method for infants under 3 months in the studied hospital.
- While UC had a lower contamination rate, it was not significantly different from CCUST.
- CCUST offers a viable, non-invasive alternative to UC for diagnosing UTIs in infants.
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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