797 Service evaluation of routine culture of negative catheter urine dipstick in a paediatric emergency department. (17th August 2022)

• Record Type: Journal Article
• Authors: Maduemem, Kene; Layman, Shoshana; Kanani, Anand
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A18
• Page End: A18
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.29
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Urine dipstick is one of the most frequently completed investigations in the paediatric emergency department. In our institution, an in and out catheter is the default mode of urine collection in all patients under 1 year of age. Regardless of the dipstick results, all catheter samples collected are sent for microscopy and culture. This project aimed to ascertain the rate of a positive culture in those catheter samples where dipstick was not suggestive of a urinary tract infection (UTI). Methods: The electronic patient records of infants whose catheter urine samples were sent for microscopy and culture between October 2020 and March 2021 were reviewed. Patients under 90 days of age, infants with a history of recurrent UTIs and those with known renal structural abnormalities were excluded. Results: Complete data for 56 episodes from 54 children was available. The median age was 8 months with female to male ratio of 1.2:1. In 57% (32/56) of samples, the dipstick was suggestive of a urinary tract infection (UTI). Nitrites was positive on dipstick in 50% (16/32) while leucocyte esterase was positive in 100% (32/32). Positive dipstick to both nitrite and leucocyte esterase was found in 47% (15/32) of samples. None of the 24 negative samples had growth on culture. Conclusion: In infants older than 90 days, without a history of recurrent UTIs or structural renal anomalies, the absence of nitrites and leucocytes esterase in a catheter obtained urine sample negates the need for routine culture. This pragmatic approach would yield a significant clinical and cost improvement for our institution.