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Outpatient urine collection methods for paediatric urinary tract infections: Systematic review of diagnostic accuracy
Hanne Ann Boon1, Wouter Lenaerts1, Cedric Van Aerde1
1EPI-Centre, Academic Centre for General Practice, KU Leuven, Leuven, Belgium.
Insights
Clean-catch urine collection is accurate for diagnosing urinary tract infections in young infants. Adhesive bags and nappy pads have high contamination rates, making them less reliable for pediatric UTI diagnosis.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Test Accuracy
- Urology
Background:
- Urinary tract infections (UTIs) are common in children.
- Accurate urine collection is crucial for timely diagnosis and treatment.
- Current collection methods vary in accuracy and contamination rates.
Purpose of the Study:
- To evaluate the diagnostic accuracy of different urine collection methods for UTIs in outpatient children.
- To compare the sensitivity, specificity, and contamination rates of various pediatric urine sampling techniques.
Main Methods:
- Systematic literature review of studies published until April 2021.
- Included outpatient children under 18 years diagnosed with UTIs.
- Analyzed diagnostic test accuracy using sensitivities, specificities, and likelihood ratios; contamination rates were a secondary outcome.
Main Results:
- Clean-catch method showed high sensitivity (97%) and specificity (89%) in infants under 90 days compared to catheterization.
- Adhesive bags demonstrated 83% sensitivity and 91% specificity versus catheterization.
- Contamination rates were 5% for clean catch, 30%-80% for adhesive bags, and 64% for nappy pads.
Conclusions:
- Adhesive bags and nappy pads, while easy to use, are highly prone to sample contamination.
- Clean-catch urine sampling presents a viable and accurate alternative for diagnosing UTIs in young infants in ambulatory settings.
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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