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Combined suprapubic aspiration and clean-voided urine examination in infants and children.

Author(s): Aronson AS, Gustafson B, Svenningsen NW

Publication: Acta Paediatr Scand, 1973, Vol. 62, Page 396-400

PubMed ID: 4738132 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study compared bacterial loads in paired SPA and clean-catch urine from 120 pediatric patients previously diagnosed with bacteriuria or leukocyturia and investigated the effects of patient age and gender on the concordance.  First-morning (children 3-12 years) or after feeding (infants, 0-18 months) clean-catch urine specimens were obtained simultaneously or immediately following SPA using a 25-gauge needle. The vulva, preputial folds, and perineum were cleaned with saline prior to collection of clean-catch urine. The clean-catch specimen was collected into a urine bag from infants after feeding, but was collected mid-stream from children. All urine specimens were chilled for transport to the laboratory where they were used for bacterial culture and leukocyte counting.  Urinary tract infection was defined as ≥10² cfu/mL in SPA urine and was suspected if >10⁵cfu/mL in clean-catch urine. 

   Summary of Findings:

   Overall, clean-catch urine resulted in a false negative for UTI in 8 of 120 patients, a false positive in 31 of 120 patients, and properly diagnosed UTI in 30 of 120 patients. In infants, 4 of 86 patients (3 boys and 1 girl) diagnosed with UTI based on SPA had a bacterial load below the threshold for UTI diagnosis in the clean-catch specimen and 27 patients (13 boys and 14 girls) had contaminated clean-catch specimens (growth in clean-catch but not SPA specimen).  Importantly, as contamination occurred at a similar rate but infection was less common in infant girls, the clean-catch specimen could be considered a false positive in only 13 of 30 boys but 14 of 17 girls who had growth in the clean-catch specimen. In children aged 3-12, 4 of 34 patients (1 boy and 3 girls) diagnosed with UTI based on SPA had bacterial loads below the threshold for UTI diagnosis in the clean-catch specimen and contamination of the clean-catch specimen was found in 7 of 13 boys and 9 of 21 girls. Finally, UTI was more likely to be found in boys than girls less than 18 months (20 of 45 versus 4 of 41), but girls were more likely to have a UTI than boys in children 3-12 years old (10 of 21 and 4 of 13). 

   Biospecimens

   • Bodily Fluid - Urine

   Preservative Types

   • None (Fresh)

   Diagnoses:

   • Other diagnoses

   Platform:

   Analyte	Technology Platform
   Cell count/volume	Light microscopy
   Cell count/volume	Microbiological assay

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Biospecimen Acquisition	Method of fluid acquisition	Needle Different urine collection procedures compared Voided urine (spot collection)
   Preaquisition	Patient age	0-18 months 3-12 years
   Preaquisition	Patient gender	Female Male

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2. Study Purpose

   This study compared leukocyte loads in paired SPA and clean-catch urine from 120 pediatric patients previously diagnosed with bacteriuria or leukocyturia and investigated the effects of patient age and the presence of bacteriuria on the concordance.  First-morning (children) or after feeding (infants) clean-catch urine specimens were obtained simultaneously or immediately following SPA using a 25-gauge needle. The vulva, preputial folds, and perineum were cleaned with saline prior to collection of clean-catch urine. The clean-catch specimen was collected into a urine bag from infants after feeding, but was collected mid-stream from children. All urine specimens were chilled for transport to the laboratory where they were used for bacterial culture and leukocyte counting.  Urinary tract infection was defined as ≥10² cfu/mL in SPA urine and was suspected if >10⁵cfu/mL in clean-catch urine. Leukocytes counts of >10 cells/mm³ in SPA (regardless of patient age) and in clean-catch specimens from children 3-12 years old were considered leukocyturia, but leukocyturia was defined as >250 cells/ mm³ in clean voided urine from infants.

   Summary of Findings:

   All infants with ≤10 leukocytes/mm³ in the SPA specimen had <250 leukocytes/mm³ in the clean-catch specimen and only one specimen (diagnosed as an infection) with >10 leukocytes/mm³ in the SPA had <250 leukocytes/mm³ in the SPA.  Further, leukocyturia was present in 21 of 24 cases of bacteriuria and was not present in the absence of bacteriuria in infants.  All but one child with > 10 leukocytes/mm³ in the SPA also had >10 leukocytes/mm³ in the clean-catch specimen, but 4 children with ≤10 leukocytes/mm³ in the SPA specimen had > 10 leukocytes/mm³ in the clean-catch specimen. In children, only one of 14 cases of bacteriuria did not have >10 leukocytes/mm³ in the SPA specimen but nine had >10 leukocytes/mm³ in the absence of bacteriuria.

   Biospecimens

   • Bodily Fluid - Urine

   Preservative Types

   • None (Fresh)

   Diagnoses:

   • Other diagnoses

   Platform:

   Analyte	Technology Platform
   Cell count/volume	Microbiological assay
   Cell count/volume	Light microscopy

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Preaquisition	Patient gender	Female Male
   Biospecimen Acquisition	Method of fluid acquisition	Needle Different urine collection procedures compared Voided urine (spot collection)
   Preaquisition	Diagnosis/ patient condition	Bacteriuria found No bacteriuria found
   Preaquisition	Patient age	0-18 months 3-12 years

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