“Ideally, SPA should be used for microbiological assessment of urine in young children,” states the abstract conclusion for this article from Australia.
Looking retrospectively at urine samples from 599 children with an average age of 7 months, these authors conclude that suprapubic aspiration is superior to all other methods of obtaining urine samples for contamination rates. Contamination rates were 46% with bag urine, 26% for clean catch, 12% for catheterization, and 1% for suprapubic aspiration.
We generally rely on catheterized urine samples in our Emergency Departments – and we even have difficulty convincing some parents that this is required, let alone a suprapubic aspiration. In fact, I’m rather surprised they had 84 patients (14%) in their cohort receiving suprapubic aspiration, considering I have never seen it performed.
While I have no issue with their conclusion from a microbiologic accuracy standpoint, I’m not so sure such an invasive and painful procedure has a place in routine practice.
“Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: An observational cohort study.“
www.ncbi.nlm.nih.gov/pubmed/22537082
2 thoughts on “Suprapubic Tap Should Be Used for Urinalysis in Children?”
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I agree with you Ryan on this one! The significance of culture proven UTI in kids is questionable >one yo children. We used to think we had to prove it definitely as it meant a bunch of further tests, long term oral antibiotics and even possibly surgery for VUR.
The evidence for all this has come full circle and I believe a clinical diagnosis is sufficient nowadays. I still get the culture specimen, with a catheter or clean catch but treat on clinical grounds and followup closely
I get a renal USS after first presentation and do more. testing if recurrent UTI clinical episodes. I dont put kids on long term oral antibiotics routinely anymore
Great analysis- this is part of the problem with the Balkanization of medicine: what's good for microbiology isn't necessarily good in the ED, the PMD's office, or for the patient.