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Published in: Pediatric Nephrology 10/2019

01-10-2019 | Urinary Tract Infection | Editorial Commentary

Defining urinary tract infection by bacterial colony counts: a case for 100,000 colonies/ml as the best threshold

Author: Malcolm G. Coulthard

Published in: Pediatric Nephrology | Issue 10/2019

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Excerpt

Urinary tract infections (UTIs) are common in childhood and cause a considerable health burden. Though many children have mild symptoms and are easily treated, some present severely unwell with urosepsis. UTIs may be associated with renal scarring, and in severe cases with hypertension, and renal impairment. They should be treated promptly to relieve symptoms and ideally within three days in infants < 2 years of age to reduce their risk of developing permanent kidney scars [1, 2]. Virtually all authors, including the American Academy of Pediatrics (AAP) [3, 4] and the UK National Institute for Health and Clinical Excellence (NICE) [5], emphasise the importance of rapid antibiotic treatment in the very young to reduce sequelae. …
Literature
1.
go back to reference Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir M, Matthews JNS (2014) Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits. Arch Dis Child 99:342–347CrossRefPubMed Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir M, Matthews JNS (2014) Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits. Arch Dis Child 99:342–347CrossRefPubMed
2.
go back to reference Karavanaki KA, Soldatou A, Koufadaki AM, Tsentidis C, Haliotis FA, Stefanadis CJ (2017) Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring. Acta Paediatr 106:149–154CrossRefPubMed Karavanaki KA, Soldatou A, Koufadaki AM, Tsentidis C, Haliotis FA, Stefanadis CJ (2017) Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring. Acta Paediatr 106:149–154CrossRefPubMed
3.
go back to reference American Academy of Pediatrics (1999) Practice parameter: the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatr 103:834–852 American Academy of Pediatrics (1999) Practice parameter: the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatr 103:834–852
4.
go back to reference American Academy of Pediatrics (2011) Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatr 128:595–610CrossRef American Academy of Pediatrics (2011) Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatr 128:595–610CrossRef
6.
go back to reference Coulthard MG, Coulthard T (2019) The leaf plot: a novel way of presenting the value of tests. Br J Gen Pract 69:205–206CrossRefPubMed Coulthard MG, Coulthard T (2019) The leaf plot: a novel way of presenting the value of tests. Br J Gen Pract 69:205–206CrossRefPubMed
7.
go back to reference Pryles CV, Eliot CR (1965) Pyuria and bacteriuria in infants and children. Am J Dis Child 110:628–635CrossRefPubMed Pryles CV, Eliot CR (1965) Pyuria and bacteriuria in infants and children. Am J Dis Child 110:628–635CrossRefPubMed
10.
go back to reference Coulthard MG (2019) Using urine nitrite sticks to test for urinary tract infection in children aged <2 years: a meta-analysis. Pediatr Nephrol 34:1283–1288CrossRefPubMed Coulthard MG (2019) Using urine nitrite sticks to test for urinary tract infection in children aged <2 years: a meta-analysis. Pediatr Nephrol 34:1283–1288CrossRefPubMed
11.
go back to reference Kass EH (1956) Asymptomatic infections of the urinary tract. Trans Assoc Am Phys 69:56–65PubMed Kass EH (1956) Asymptomatic infections of the urinary tract. Trans Assoc Am Phys 69:56–65PubMed
12.
go back to reference Kass EH (1957) Bacteriuria and the diagnosis of infections of the urinary tract. JAMA Intern Med 100:709–714 Kass EH (1957) Bacteriuria and the diagnosis of infections of the urinary tract. JAMA Intern Med 100:709–714
13.
go back to reference Saccharow L, Pryles CV (1969) Further experience with the use of percutaneous suprapubic aspiration of the urinary bladder. Pediatr 43:1018–1024 Saccharow L, Pryles CV (1969) Further experience with the use of percutaneous suprapubic aspiration of the urinary bladder. Pediatr 43:1018–1024
14.
go back to reference Bergwall B, Ljungblom B-A (1972) Suprapubic aspiration of the urinary bladder for accurate diagnosis of urinary tract infections in children. Acta Paediatr Scand 61:390 Bergwall B, Ljungblom B-A (1972) Suprapubic aspiration of the urinary bladder for accurate diagnosis of urinary tract infections in children. Acta Paediatr Scand 61:390
15.
16.
go back to reference Aronson AS, Gustafson B, Svenningsen NW (1973) Combined suprapubic aspiration and clean-voided urine examination in infants and children. Acta Paediatr Scand 62:396–400CrossRefPubMed Aronson AS, Gustafson B, Svenningsen NW (1973) Combined suprapubic aspiration and clean-voided urine examination in infants and children. Acta Paediatr Scand 62:396–400CrossRefPubMed
17.
go back to reference Ramage IJ, Chapman JP, Hollman AS, Elabassi M, McColl JH, Beattie TJ (1999) Accuracy of clean-catch urine collection in infancy. J Pediatr 135:765–767CrossRefPubMed Ramage IJ, Chapman JP, Hollman AS, Elabassi M, McColl JH, Beattie TJ (1999) Accuracy of clean-catch urine collection in infancy. J Pediatr 135:765–767CrossRefPubMed
18.
go back to reference Verliat-Guignaud J, Blanc P, Garnier F, Gajdos V, Guigonis V (2015) A midstream urine collector is not a good alternative to a sterile collection method during the diagnosis of urinary tract infection. Acta Paediatr 104:e395–e400CrossRef Verliat-Guignaud J, Blanc P, Garnier F, Gajdos V, Guigonis V (2015) A midstream urine collector is not a good alternative to a sterile collection method during the diagnosis of urinary tract infection. Acta Paediatr 104:e395–e400CrossRef
19.
go back to reference Megged O, Zilberstein L, Shalom EB, Erlichman M (2017) Contamination of urinary cultures in initial-stream versus later-stream urine in children undergoing bladder catheterisation for the diagnosis of urinary tract infection. Eur J Emerg Med 24:e17–e20CrossRefPubMed Megged O, Zilberstein L, Shalom EB, Erlichman M (2017) Contamination of urinary cultures in initial-stream versus later-stream urine in children undergoing bladder catheterisation for the diagnosis of urinary tract infection. Eur J Emerg Med 24:e17–e20CrossRefPubMed
20.
go back to reference Coulthard MG, Kalra M, Lambert HJ, Nelson A, Smith T, Perry JD (2010) Redefining urinary tract infections by bacterial colony counts. Pediatr 125:335–341CrossRef Coulthard MG, Kalra M, Lambert HJ, Nelson A, Smith T, Perry JD (2010) Redefining urinary tract infections by bacterial colony counts. Pediatr 125:335–341CrossRef
21.
go back to reference Pryles CV, Steg LN (1959) Specimens of urine obtained from young girls by catheter vs voiding. Pediatr 23:441–452 Pryles CV, Steg LN (1959) Specimens of urine obtained from young girls by catheter vs voiding. Pediatr 23:441–452
22.
go back to reference Kunin CM, Southall I, Paquin AJ (1960) Epidemiology of urinary-tract infections: a pilot study of 3057 school children. NEJM 263:817–823CrossRefPubMed Kunin CM, Southall I, Paquin AJ (1960) Epidemiology of urinary-tract infections: a pilot study of 3057 school children. NEJM 263:817–823CrossRefPubMed
23.
go back to reference Pryles CV, Luders D, Alkan MK (1961) Colony counts in paired specimens of urine obtained by catheter versus voiding from normal infants and infants with urinary tract infection. Pediatr 27:17–28 Pryles CV, Luders D, Alkan MK (1961) Colony counts in paired specimens of urine obtained by catheter versus voiding from normal infants and infants with urinary tract infection. Pediatr 27:17–28
24.
go back to reference McCarthy JM, Pryles CV (1963) Clean voided and catheter neonatal urine specimens. Am J Dis Child 106:473–478CrossRefPubMed McCarthy JM, Pryles CV (1963) Clean voided and catheter neonatal urine specimens. Am J Dis Child 106:473–478CrossRefPubMed
25.
go back to reference Nelson JD, Peters PC (1965) Suprapubic aspiration of urine in premature and term infants. Pediatr 36:132–134 Nelson JD, Peters PC (1965) Suprapubic aspiration of urine in premature and term infants. Pediatr 36:132–134
27.
go back to reference Sharma SK, Singh SM, Bapna BC (1973) Comparison of the bacterial flora and colony counts of the paired urine samples obtained by suprapubic aspiration and clean voided mid-stream at the All-India Institute of Medical Sciences Hospital, New Delhi. Indian J Med Res 61:179–183PubMed Sharma SK, Singh SM, Bapna BC (1973) Comparison of the bacterial flora and colony counts of the paired urine samples obtained by suprapubic aspiration and clean voided mid-stream at the All-India Institute of Medical Sciences Hospital, New Delhi. Indian J Med Res 61:179–183PubMed
28.
go back to reference Hardy JD, Furnell PM, Brumfitt W (1976) Comparison of sterile bag, clean catch and suprapubic aspiration in the diagnosis of urinary infection in early childhood. Br J Urol 48:279–283CrossRefPubMed Hardy JD, Furnell PM, Brumfitt W (1976) Comparison of sterile bag, clean catch and suprapubic aspiration in the diagnosis of urinary infection in early childhood. Br J Urol 48:279–283CrossRefPubMed
29.
go back to reference Liaw LCT, Nayar DM, Pedler SJ, Coulthard MG (2000) Home collection of urine for culture from infants by three methods: survey of parents’ preferences and bacterial contamination rates. BMJ 320:1312–1313CrossRefPubMedPubMedCentral Liaw LCT, Nayar DM, Pedler SJ, Coulthard MG (2000) Home collection of urine for culture from infants by three methods: survey of parents’ preferences and bacterial contamination rates. BMJ 320:1312–1313CrossRefPubMedPubMedCentral
30.
go back to reference Alam MT, Coulter JBS, Pacheo J, Correia JB, Ribeiro MGB, Coelho MFC, Bunn JEG (2005) Comparison of urine contamination rates using three different methods of collection: clean-catch, cotton wool pad and urine pad. Ann Trop Paediatr 25:29–34CrossRefPubMed Alam MT, Coulter JBS, Pacheo J, Correia JB, Ribeiro MGB, Coelho MFC, Bunn JEG (2005) Comparison of urine contamination rates using three different methods of collection: clean-catch, cotton wool pad and urine pad. Ann Trop Paediatr 25:29–34CrossRefPubMed
31.
go back to reference Lau AY, Wong S-N, Yip K-T, Fong K-W, Li SP-S, Que T-L (2007) A comparative study on bacterial cultures of urine samples obtained by clean-void technique versus urethral catheterization. Acta Paediatr 96:432–436CrossRefPubMed Lau AY, Wong S-N, Yip K-T, Fong K-W, Li SP-S, Que T-L (2007) A comparative study on bacterial cultures of urine samples obtained by clean-void technique versus urethral catheterization. Acta Paediatr 96:432–436CrossRefPubMed
32.
go back to reference Pylkkanen J, Vilska J, Koskimies O (1979) Diagnostic value of symptoms and clean-voided urine specimen in childhood urinary tract infection. Acta Paediatr Scand 68:341–344CrossRefPubMed Pylkkanen J, Vilska J, Koskimies O (1979) Diagnostic value of symptoms and clean-voided urine specimen in childhood urinary tract infection. Acta Paediatr Scand 68:341–344CrossRefPubMed
33.
go back to reference Amir J, Ginzburg M, Staussberg R, Varsano I (1993) The reliability of midstream urine culture from circumcised male infants. Am J Dis Child 147:969–970PubMed Amir J, Ginzburg M, Staussberg R, Varsano I (1993) The reliability of midstream urine culture from circumcised male infants. Am J Dis Child 147:969–970PubMed
34.
go back to reference Herreros ML, Tagarro A, Garcia-Pose A, Sanchez A, Canete A, Gili P (2018) Performing a urine dipstick test with a clean-catch urine sample is an accurate screening method for urinary tract infections in young infants. Acta Paediatr 107:145–150CrossRefPubMed Herreros ML, Tagarro A, Garcia-Pose A, Sanchez A, Canete A, Gili P (2018) Performing a urine dipstick test with a clean-catch urine sample is an accurate screening method for urinary tract infections in young infants. Acta Paediatr 107:145–150CrossRefPubMed
35.
36.
go back to reference Stamey TA (1972) Urinary tract infections. Williams & Williams, Baltimore, pp 1–29 Stamey TA (1972) Urinary tract infections. Williams & Williams, Baltimore, pp 1–29
37.
go back to reference Pryles CV, Atkin MD, Morse TS, Welch KJ (1959) Comparative bacteriologic study of urine obtained from children by percutaneous suprapubic aspiration of the bladder and by catheter. Pediatr 24:983–991 Pryles CV, Atkin MD, Morse TS, Welch KJ (1959) Comparative bacteriologic study of urine obtained from children by percutaneous suprapubic aspiration of the bladder and by catheter. Pediatr 24:983–991
38.
go back to reference Hellerstein S (1982) Recurrent urinary tract infections in children. Pediatr Infect Dis J 1:271–281CrossRef Hellerstein S (1982) Recurrent urinary tract infections in children. Pediatr Infect Dis J 1:271–281CrossRef
40.
go back to reference Tobiansky R, Evans N (1998) A randomized controlled trial of two methods for collection of sterile urine in neonates. J Paediatr Child Health 34:460–462CrossRefPubMed Tobiansky R, Evans N (1998) A randomized controlled trial of two methods for collection of sterile urine in neonates. J Paediatr Child Health 34:460–462CrossRefPubMed
41.
go back to reference Karacan C, Erkek N, Senel S, Gunduz SA, Catli G (2010) Evaluation of urine collection methods for the diagnosis of urinary tract infection in children. Med Princ Pract 19:188–191CrossRefPubMed Karacan C, Erkek N, Senel S, Gunduz SA, Catli G (2010) Evaluation of urine collection methods for the diagnosis of urinary tract infection in children. Med Princ Pract 19:188–191CrossRefPubMed
42.
go back to reference Etoubleau C, Reveret M, Brouet D, Badier I, Brosset P, Fourcarde L, Bahans C, Garnier F, Blanc P, Guigonis V (2009) Moving from bag to catheter for urine collection in non-toilet-trained children suspected of having urinary tract infection: a paired comparison of urine cultures. J Pediatr 154:803–806CrossRefPubMed Etoubleau C, Reveret M, Brouet D, Badier I, Brosset P, Fourcarde L, Bahans C, Garnier F, Blanc P, Guigonis V (2009) Moving from bag to catheter for urine collection in non-toilet-trained children suspected of having urinary tract infection: a paired comparison of urine cultures. J Pediatr 154:803–806CrossRefPubMed
43.
go back to reference McGillivray D, Mok E, Mulrooney E, Kramer MS (2005) A head-to-head comparison: “clean-void” bag versus catheter urinalysis in the diagnosis of urinary tract infection in young children. J Pediatr 147:451–456CrossRefPubMed McGillivray D, Mok E, Mulrooney E, Kramer MS (2005) A head-to-head comparison: “clean-void” bag versus catheter urinalysis in the diagnosis of urinary tract infection in young children. J Pediatr 147:451–456CrossRefPubMed
44.
go back to reference Al-Orifi F, McGillivray D, Tange S, Kramer MS (2000) Urine culture from bag specimens in young children: are the risks too high? J Pediatr 137:221–226CrossRefPubMed Al-Orifi F, McGillivray D, Tange S, Kramer MS (2000) Urine culture from bag specimens in young children: are the risks too high? J Pediatr 137:221–226CrossRefPubMed
45.
go back to reference Swerkersson S, Jodal U, Ahren C, Sixt R, Stoklanad E, Hansson S (2016) Urinary tract infection in infants: the significance of low bacterial count. Pediatr Nephrol 31:239–245CrossRefPubMed Swerkersson S, Jodal U, Ahren C, Sixt R, Stoklanad E, Hansson S (2016) Urinary tract infection in infants: the significance of low bacterial count. Pediatr Nephrol 31:239–245CrossRefPubMed
46.
go back to reference Tosif S, Baker A, Oakley E, Donath S, Babl FE (2012) Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: an observational cohort study. J Paediatr Child Health 48:659–664CrossRefPubMed Tosif S, Baker A, Oakley E, Donath S, Babl FE (2012) Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: an observational cohort study. J Paediatr Child Health 48:659–664CrossRefPubMed
47.
go back to reference Austin BJ, Bollard C, Gunn TR (1999) Is urethral catheterisation a successful alternative to suprapubic aspiration in neonates? J Paediatr Child Health 35:34–36CrossRefPubMed Austin BJ, Bollard C, Gunn TR (1999) Is urethral catheterisation a successful alternative to suprapubic aspiration in neonates? J Paediatr Child Health 35:34–36CrossRefPubMed
48.
go back to reference Pollack CV, Pollack ES, Andrew ME (1994) Suprapubic bladder aspiration versus urethral catheterisation in ill infants: success, efficiency, and complication rates. Ann Emerg Med 23:225–230CrossRefPubMed Pollack CV, Pollack ES, Andrew ME (1994) Suprapubic bladder aspiration versus urethral catheterisation in ill infants: success, efficiency, and complication rates. Ann Emerg Med 23:225–230CrossRefPubMed
49.
go back to reference Li PS, Ma LC, Wong SN (2002) Is bag urine culture useful in monitoring urinary tract infection in infants? J Paediatr Child Health 38:377–381CrossRefPubMed Li PS, Ma LC, Wong SN (2002) Is bag urine culture useful in monitoring urinary tract infection in infants? J Paediatr Child Health 38:377–381CrossRefPubMed
50.
go back to reference Armengol CE, Hendley JO, Schlager TA (2001) Should we abandon standard microscopy when screening for urinary tract infections in young children. Pediatr Infect Dis J 20:1176–1177CrossRefPubMed Armengol CE, Hendley JO, Schlager TA (2001) Should we abandon standard microscopy when screening for urinary tract infections in young children. Pediatr Infect Dis J 20:1176–1177CrossRefPubMed
51.
go back to reference Shaw KN (1998) Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatr 101:e1065CrossRef Shaw KN (1998) Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatr 101:e1065CrossRef
52.
go back to reference Gilljam B-M, Svensson M-L (2008) In-out catheterization of young children with suspected urinary tract infection: a retrospective journal study. Pediatr Nurs 34:241–245PubMed Gilljam B-M, Svensson M-L (2008) In-out catheterization of young children with suspected urinary tract infection: a retrospective journal study. Pediatr Nurs 34:241–245PubMed
53.
go back to reference Dayan PS, Chamberlain JM, Boenning D, Adirim T, Schor J, Klein BL (2000) A comparison of the initial to the later stream urine in children catheterized to evaluate for a urinary tract infection. Pediatr Emerg Care 16:88–90CrossRefPubMed Dayan PS, Chamberlain JM, Boenning D, Adirim T, Schor J, Klein BL (2000) A comparison of the initial to the later stream urine in children catheterized to evaluate for a urinary tract infection. Pediatr Emerg Care 16:88–90CrossRefPubMed
54.
go back to reference Coutinho K, Stensland K, Akhavan A, Jayadevan R, Stock JA (2014) Pediatrician noncompliance with the American Academy of Pediatrics guidelines for the workup of UTI in infants. Clin Pediatr 53:1139–1148CrossRef Coutinho K, Stensland K, Akhavan A, Jayadevan R, Stock JA (2014) Pediatrician noncompliance with the American Academy of Pediatrics guidelines for the workup of UTI in infants. Clin Pediatr 53:1139–1148CrossRef
55.
go back to reference Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Donath SM, Bryant PA, Babl FE (2017) Faster clean catch urine collection (Quick-Wee method) from infants; randomised controlled trial. BMJ 357:j1341CrossRefPubMedPubMedCentral Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Donath SM, Bryant PA, Babl FE (2017) Faster clean catch urine collection (Quick-Wee method) from infants; randomised controlled trial. BMJ 357:j1341CrossRefPubMedPubMedCentral
56.
go back to reference Coulthard MG, Nelson A, Smith T, Perry JD (2010) Point-of-care diagnostic tests for childhood urinary tract infection: phase-contrast microscopy for bacteria, stick-testing, and counting white blood cells. J Clin Pathol 63:823–829CrossRefPubMed Coulthard MG, Nelson A, Smith T, Perry JD (2010) Point-of-care diagnostic tests for childhood urinary tract infection: phase-contrast microscopy for bacteria, stick-testing, and counting white blood cells. J Clin Pathol 63:823–829CrossRefPubMed
57.
go back to reference Downing H, Thomas-Jones E, Gal M, Waldron C-A, Sterne J, Hollingworth W, Hood K, Delaney B, Little P, Howe R, Wooton M, Macgowan A, Butler CC, Hay AD (2012) The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness. BMC Infect Dis 12:158CrossRefPubMedPubMedCentral Downing H, Thomas-Jones E, Gal M, Waldron C-A, Sterne J, Hollingworth W, Hood K, Delaney B, Little P, Howe R, Wooton M, Macgowan A, Butler CC, Hay AD (2012) The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness. BMC Infect Dis 12:158CrossRefPubMedPubMedCentral
58.
go back to reference Birnie K, Hay AD, Wootton M, Howe R, MacGowan A, Whiting P, Lawton M, Delaney B, Downing H, Dudley J, Hollingworth W, Lisles C, Little P, O'Brien K, Pickles T, Rumsby K, Thomas-Jones E, Van der Voort J, Waldron C-A, Harman K, Hood K, Butler CC, Sterne JAC (2017) Comparison of microbiological diagnosis of urinary tract infection in young children by routine health service laboratories and a research laboratory: diagnostic cohort study. PLoS One 12. https://doi.org/10.1371/journal.pone.017113 Birnie K, Hay AD, Wootton M, Howe R, MacGowan A, Whiting P, Lawton M, Delaney B, Downing H, Dudley J, Hollingworth W, Lisles C, Little P, O'Brien K, Pickles T, Rumsby K, Thomas-Jones E, Van der Voort J, Waldron C-A, Harman K, Hood K, Butler CC, Sterne JAC (2017) Comparison of microbiological diagnosis of urinary tract infection in young children by routine health service laboratories and a research laboratory: diagnostic cohort study. PLoS One 12. https://​doi.​org/​10.​1371/​journal.​pone.​017113
Metadata
Title
Defining urinary tract infection by bacterial colony counts: a case for 100,000 colonies/ml as the best threshold
Author
Malcolm G. Coulthard
Publication date
01-10-2019
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 10/2019
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-019-04283-x

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