Urine collection methods and dipstick testing in non-toilet-trained children
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REVIEW
Urine collection methods and dipstick testing in non-toilet-trained children James Diviney 1 & Mervyn S. Jaswon 1,2 Received: 23 April 2020 / Revised: 3 July 2020 / Accepted: 16 July 2020 # The Author(s) 2020
Abstract Urinary tract infection is a commonly occurring paediatric infection associated with significant morbidity. Diagnosis is challenging as symptoms are non-specific and definitive diagnosis requires an uncontaminated urine sample to be obtained. Common techniques for sampling in non-toilet-trained children include clean catch, bag, pad, in-out catheterisation and suprapubic aspiration. The pros and cons of each method are examined in detail in this review. They differ significantly in frequency of use, contamination rates and acceptability to parents and clinicians. National guidance of which to use differs significantly internationally. No method is clearly superior. For non-invasive testing, clean catch sampling has a lower likelihood of contamination and can be made more efficient through stimulation of voiding in younger children. In invasive testing, suprapubic aspiration gives a lower likelihood of contamination, a high success rate and a low complication rate, but is considered painful and is not preferred by parents. Urine dipstick testing is validated for ruling in or out UTI provided that leucocyte esterase (LE) and nitrite testing are used in combination. Keywords UTI . Urinary tract infection . Urine sampling . Clean catch . In-out catheterisation . Suprapubic aspiration . Dipstick testing
Introduction Urinary tract infection (UTI) is a common bacterial infection and, as such, a common presentation to paediatric health services. 5.9% of children presenting acutely to UK General Practitioners (family doctors) will have a UTI, rising to 7.3% if the population is restricted to those < 3 years old [1] and 7% of those < 2 years with urinary symptoms [2]. There are several common pathogens, with > 70% of cases due to E. coli, with c.10% involving other coliforms (including Klebsiella and Enterobacter species) and c. 5% Proteus species [3–5]. UTIs are not trivial infections, with detectable bacteraemia of the same organism in 10% of cases, rising to 17% in those < 1 month old [3]. 2.8–16% of individuals may develop kidney scarring following their first episode of UTI, with 8.4% of these developing hypertension, and a small * James Diviney [email protected] 1
Department of Paediatrics, Whittington Hospital, London, UK
2
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
proportion progressing to kidney failure [6–8]. Kidney scarring and damage can be prevented if UTI is treated in a timely manner, with delay leading to increasingly likely scarring [9, 10]. With this potentially avoidable morbidity, it is crucial to have the correct diagnosis. Clinical diagnosis is not straightforward and symptoms are non-specific, complicated by the fact that those who are most susceptible are least able to report symptoms. There is a reduction in incidence of UTI with advancing age, wh
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