Urine collection techniques in infants and children with suspected urinary tract infection
- Lalit Bajaj, MD, MPH
Lalit Bajaj, MD, MPH
- Associate Professor of Pediatrics
- Children's Hospital Colorado
- Joan Bothner, MD
Joan Bothner, MD
- Professor of Pediatrics and Emergency Medicine
- University of Colorado School of Medicine
The procedures for obtaining and processing urine samples in children are reviewed here. The diagnosis, treatment, and subsequent evaluation of urinary tract infections (UTIs) in neonates, infants, and older children are discussed separately. (See "Urinary tract infections in neonates" and "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis" and "Urinary tract infections in infants and children older than one month: Acute management, imaging, and prognosis" and "Urinary tract infections in children: Long-term management and prevention".)
The likelihood of a urinary tract infection (UTI) varies significantly in the pediatric population according to age, sex, race, circumcision status in males, and presenting signs and symptoms. Although clinicians may have variable thresholds for diagnostic testing, urine samples for urinalysis (dipstick and microscopic examination) and culture are generally indicated when the probability of a urinary tract infection is greater than 2 percent. Thus, they are appropriate in the following pediatric patients (algorithm 1A-C and table 1 and table 2). (see "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis", section on 'Decision to obtain'):
●Girls and uncircumcised boys younger than two years with at least one risk factor for UTI (history of UTI, temperature >39°C, fever without apparent source [particularly if the child will be treated with antibiotics], ill appearance, suprapubic tenderness, fever >24 hours, or nonblack race)
●Circumcised boys younger than two years with suprapubic tenderness or at least two risk factors for UTI (history of UTI, temperature >39°C, fever without apparent source [particularly if the child will be treated with antibiotics], ill appearance, suprapubic tenderness, fever >24 hours, or nonblack race)
●Girls and uncircumcised boys older than two years with any of the following urinary symptoms: abdominal pain, back pain, dysuria, frequency, high fever, or new-onset incontinence
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- SELECTION OF TECHNIQUE
- Toilet trained
- Not toilet trained
- Clean voided samples
- Transurethral bladder catheterization (TUBC)
- - Boys
- - Girls
- - Portable ultrasound
- - Complications
- Suprapubic bladder aspiration (SPA)
- - Portable ultrasound
- - Complications
- Clean voided bag samples
- PROCESSING OF URINE SAMPLES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS