Support for Bag UA Screening During Evaluation for UTI
McGillivray D, Mok E, Mulrooney E, et al. A head-to-head comparison: “clean-void” bag versus catheter urinalysis in the diagnosis of urinary tract infection in young children. J Pediatr. 2005;147(4):451-456.
Review by Jenny Geheb, RN, CPNP
Early detection of urinary tract infection (UTI) can be especially important in children. This study uses a cross-sectional design to compare the validity of the urinalysis on clean-voided bag versus catheter urine specimens using the catheter culture as the “gold” standard. This study looked at 303 non-toilet-trained children under age three at risk for UTI who presented to a children’s hospital emergency department. Paired bag and catheter specimens were obtained from each child and sent for dipstick and microscopic urinalysis. Sensitivity and specificity were compared using McNemar’s [chi]2 test for paired specimens and the ordinary [chi]2 test for unpaired comparisons.
The study, which was conducted at the Montreal Children’s Hospital, found that the bag dipstick was more sensitive than the catheter dipstick for the entire study sample: 0.85 (95% confidence interval [CI] = 0.78 to 0.93) versus 0.71 (95% CI= 0.95 to 0.99), respectively. Both bag and catheter dipstick sensitivities were lower in infants <90 days old. Specificity was consistently lower for the bag specimens than for the catheter specimens.
A child at high risk for UTI (previous history of UTI, anatomic abnormalities, immunosuppressed, or presence of urinary symptoms) should be catheterized to obtain both a UA and culture; however, in children older than 90 days with fever without source and at low risk for UTI, a “selective catheterization” approach, as outlined in the American Academy of Pediatrics practice parameter, appears to be reasonable.
In low-risk children, serious consequences of infection are less likely, and the authors propose that the risks of missing a UTI are likely to be outweighed by the risks of catheterization, including pain, false-positive result, trauma, introduction of infection, test resistance by staff, and parental concern.
In summary, the provider may choose to use a bag urine screening strategy to reduce the number of unnecessary catheterizations in children who are considered low risk and over 90 days old. Further studies are needed to analyze the cost-benefit ratio of this approach as well as to confirm these findings with larger populations.
Short-Course Antibiotic Treatment for Streptococcal Pharyngitis
Casey JR, Pichichero ME. Meta-analysis of short course antibiotic treatment for group A streptococcal tonsillopharyngitis. Ped Infect Dis J. 2005;24(10):909-917.
Review by Jenny Geheb, RN, CPNP
Group A streptococcal (GAS) tonsillopharyngitis is a common cause for antibiotic treatment in children. Researchers at the University of Rochester Medical Center (N.Y.) performed a meta-analysis of current data to compare bacterial and clinical cure rates in patients with GAS tonsillopharyngitis treated with short course antibiotic treatment with oral [beta]-lactam or macrolide antibiotics for four to five days with standard 10-day treatment courses. Medline, Embase, reference lists, and abstract searches were all used to identify applicable publications. Trials were included if there was bacteriologic confirmation of GAS tonsillopharyngitis, random assignment to antibiotic therapy for a [beta]-lactam or macrolide antibiotic of shortened course versus a 10-day course, and assessment of bacteriologic outcome using a throat culture.
Twenty-two trials involving 7,470 patients were included in four separate analyses. Trials were grouped by a short course of cephalosporins (n=14), macrolides (other than azithromycin) (n=6), penicillin (n=2), and amoxicillin (n=2). Cephalosporin trials were further grouped by penicillin (n=12) or the same cephalosporin (n=3). Five trials were conducted in the United States with the remainder conducted in Europe.