Choice of urine collection methods for the diagnosis of urinary tract infection in young, febrile infants

Journal Name: 
Arch.Pediatr.Adolesc.Med
Authors: 
Schroeder,A.R.
Newman,T.B.
Wasserman,R.C.
Finch,S.A.
Pantell,R.H.
Abstract: 
BACKGROUND: The optimal method of urine collection in febrile infants is debatable; catheterization, considered more accurate, is technically difficult and invasive. OBJECTIVES: To determine predictors of urethral catheterization in febrile infants and to compare bag and catheterized urine test performance characteristics. DESIGN: Prospective analysis of infants enrolled in the Pediatric Research in Office Settings' Febrile Infant Study. SETTING: A total of 219 practices from within the Pediatric Research in Office Settings' network, including 44 states, the District of Columbia, and Puerto Rico. PATIENTS: A total of 3066 infants aged 0 to 3 months with temperatures of 38 degrees C or higher. MAIN OUTCOME MEASURES: We calculated adjusted odds ratios for predictors of catheterization. Diagnostic test characteristics were compared between bag and catheterization. Urinary tract infection was defined as pure growth of 100 000 CFU/mL or more (bag) and 20 000 CFU/mL or more (catheterization). RESULTS: Seventy percent of urine samples were obtained by catheterization. Predictors of catheterization included female sex, practitioner older than 40 years, Medicaid, Hispanic ethnicity, nighttime evaluation, and severe dehydration. For leukocyte esterase levels, bag specimens demonstrated no difference in sensitivity but somewhat lower specificity (84% [bag] vs 94% [catheterization], P
10
2005
Volume: 
159
Pages: 
915-922
Keywords: 
100, 20, 40, Aged, analysis, blood, clinical, Culture, decision, Decision Making, Diagnosis, diagnostic, District of Columbia, epidemiology, evaluation, Female, Growth, Humans, Infant, Infant,Newborn, Infection, Logistic Models, Male, Medicaid, Methods, Odds Ratio, older, patient, Patients, Pediatrics, Prospective Studies, Puerto Rico, Research, Research Support, Risk, ROC Curve, San Francisco, Specimen Handling, support, Universities, Urinary Tract Infections, urine