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Urine collection methods for infants under 3 months of age in clinical practice

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Abstract

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.

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Abbreviations

CCUST:

clean-catch urine stimulation technique

UC:

urethral catheterization

UB:

urine bag

CI:

confidence interval

UTI:

urinary tract infection

IQR:

interquartile range

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Acknowledgements

The authors thank Kenneth McCreath for editing the manuscript.

Funding

The authors received no external funding for this manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain

    María Luisa Herreros, Rut del Valle, Ana Barrios & Mónica Pacheco

  2. Universidad Europea, Madrid, Spain

    María Luisa Herreros, Rut del Valle, Ana Barrios & Mónica Pacheco

  3. Hospital Universitario Fundación Alcorcón, Madrid, Spain

    Pablo Gili

  4. Department of Microbiology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain

    Aida Sánchez

Authors
  1. María Luisa Herreros
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Contributions

Dr. M.L. Herreros: 1) Substantial contributions to the conception, design of the work, and the acquisition, analysis or interpretation of data; 2) Drafting the work and revising it critically; 3) Final approval of the version published; and 4) agreement to be accountable for all aspects of the work.

Dr. P. Gili: 1) Substantial contributions to the conception, design of the work, analysis and interpretation of data; 2) drafting the work and revising it critically; 3) Final approval of the version published; and 4) agreement to be accountable for all aspects of the work.

Dr. R. del Valle, Dr. M. Pacheco and Dr. A. Barrios: 1) Substantial contributions to the acquisition, analysis and interpretation of data; 2) drafting the work and revising it critically; 3) final approval of the version published; and 4) agreement to be accountable for all aspects of the work.

Dr. Aida Sánchez: 1) Substantial contributions to the conception and design of the work, and the acquisition, analysis and interpretation of data; 2) drafting the work and revising it critically; 3) final approval of the version published; and 4) agreement to be accountable for all aspects of the work.

Corresponding author

Correspondence to María Luisa Herreros.

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Hospital Universitario Infanta Sofía Research Commission number 12/05/2020

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The authors declare no competing interests.

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Herreros, M.L., Gili, P., del Valle, R. et al. Urine collection methods for infants under 3 months of age in clinical practice. Pediatr Nephrol 36, 3899–3904 (2021). https://doi.org/10.1007/s00467-021-05142-4

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