Automatic urine cultures from catheter-obtained samples-time to implement a practice change to improve value

Area of Science:

• Pediatric Emergency Medicine
• Clinical Microbiology
• Urology

Background:

• Urinary tract infections (UTIs) are common in young children.
• Urine cultures are frequently obtained via catheterization in pediatric emergency departments (EDs), even without pyuria, to rule out UTIs.
• This practice aligns with older guidelines but may conflict with newer recommendations and current resource utilization strategies.

Purpose of the Study:

• To determine the frequency and characteristics of children aged 6 to 24 months with normal urinalysis (UA) and positive urine culture after catheterization.
• To describe the clinical course of these children.
• To evaluate the utility of routine urine cultures in this population.

Main Methods:

• Retrospective cohort study of 818 children aged 6 to 24 months undergoing urine catheterization in a single Pediatric ED.
• Analysis of point-of-care (POC) UA results, urine culture data, and follow-up phone call documentation.
• Descriptive statistics were used to analyze the data.

Main Results:

• 131 (16%) of 818 urine cultures were positive.
• 14 patients (10.7% of positive cultures) had a normal POC UA.
• Most of these 14 children were asymptomatic; 3 (2.3%) remained febrile and were classified as potentially having a missed UTI.

Conclusions:

• Routine urine cultures from catheterized samples in young children, irrespective of UA results, infrequently identify missed UTIs.
• Reconsideration of this practice in low-risk children is advised, aligning with current guidelines.
• This reconsideration can enhance care quality and optimize resource utilization in ED settings.