Effect of urethral meatus cleansing on midstream urine contamination rate in boys
Keywords:
clean-catch, non clean-catch, midstream urine, contamination rate
Abstract
Background Clean-catch midstream urine (MSU) remains thestandard procedure for urine collection even if it's role to reduce
bacterial contamination rate is unclear.
Objective To compare bacterial contamination rate between
clean-catch (cleaning urethral meatus with medicated soap) and
non clean-catch MSU among boys.
Methods An experimental study with parallel groups and block
randomization was conducted. Toilet-trained boys aged 3 to 18
years, without symptoms or signs of urinary tract infection were
recruited from the Pediatric Outpatient Clinic at Sardjito Hospital
and from a local elementary school. Subjects with history of renal
disease, those who were on under antibiotic treatment in the
preceding week, or with meatal abnormality or non-cooperative
were excluded. Urine specimen was collected by a trained nurse,
and was cultured within one hour by personnel blinded to the
assignment. Significant bacteriuria was defined as growth of a
single pathogenic organism (degree of pathogenicity group I-III)
with colony count 2: 105 colony forming unit/mi. Contamination
was defined as any growth not fulfilling criteria for significant
bacteriuria or growth of multiple organisms.
Results A total of 80 boys were enrolled. The contamination rate
in the clean-catch group was 13% (5 out of 40) compared with
10% (4 out of 40) in the non clean-catch group (P=l.O). The
adjusted risk ratio for contamination in the clean-catch MSU
group, adjusted to age and circumcision status, was 1.37 (95%
CI 0.42; 4.51).
Conclusion Clean-catch method does not reduce bacterial con-
tamination rate of midstream urine cultures in boys
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JS. Prevalence of urinary tract infection in febrile young
children in the emergency department. Pediatrics 1998;102
Suppl2:E16.
2. American Academy of Pediatrics. Practice parameter: the
diagnosis, treatment, and evaluation of the initial urinary
tract infection in febrile infants and young children. Com-
mittee on Quality Improvement. Subcommittee on Urinary
Tract Infection. Pediatrics 1999; 103:843-52.
3. Schroeder AR, Newman TB, Wasserman RC, Finch
SA,Pantell RH. Choice of urine collection methods for the
diagnosis of urinary tract infection in young febrile infants.
Arch Pediatr Adolesc Med 2005;59:915-22.
4. Vaillancourt S, McGillivray D, Zhang X , Kramer MS. To
clean or not to clean: effect on contamination rates in mid-
stream urine collections in toilet-trained children. Pediatrics
2007; 119:E1288-93.
5. Wiswell TE. The prepuce, urinary tract infections, and the
consequences. Pediatrics 2000; 105:860-2.
6. Long E, Vince J. Evidence behind the WHO guidelines:
hospital care for children: what are appropriate methods of
urine collection in UTI? J Trop Pediatr 2007;53:221-4.
7. Lau AY, Wong S, Yip K, Fong K, LiSP, Que T. A compara-
tive study on bacterial cultures of urine samples obtained by
clean-void technique versus urethral catheterization. Acta
Paediatrica 2007;96:432-6.
8. Zorc JJ, Kiddoo DA, Shaw KN. Diagnosis and management
of pediatric urinary tract infections. Clinical Microbiology
Reviews 2005;18:417-22.
9. Lohr JA, Donowitz LG, Dudley SM. Bacterial contamination
rates for non-clean-catch and clean-catch midstream urine
collections in boys. J Pediatr 1986; 109:659-60.
10. Leisure MK, Dudley SM, Donowitz LG. Does a clean-
catch urine sample reduce bacterial contamination? NEJM
1993;328:289-90.
11. Prandoni D, Boone MH, Larson E, Blane CG, Fitzpatrick
H. Assessment of urine collection technique for microbial
culture. Am J Infect Control1996; 24:219-21.
12. Blake DR, Doherty LF. Effect of perineal cleansing on con-
tamination rate of mid-stream urine culture. J Pediatr Adolesc
Gynecol2006;19:31-4.
13. Chua AT, Arceo E, Pena A. Comparison of initial versus
midstream voided urine for urine culture among men. Phil J
Microbial Infect Dis 1988;17:22-4.
14. Baerheim A, Digranes A, Hunskaar S. Evaluation of urine
sampling technique: Bacterial contamination of samples from
women students. Br J Gen Pract 1992;42:241-3.
15. Lifshitz E, Kramer L. Outpatient urine culture: Does collec-
tion technique matter? Arch Intern Med 2000;160:2537-
40.
16. Saez- Llorens X, Umana MA, Odio CM, Lohr JA. Bacterial
contamination rates for non-clean-catch and clean-catch
midstream urine collections in uncircumcised boys. J Pediatr
1989; 114:93-5.
17. Lohr JA, Donowitz LG, Dudley SM. Bacterial contamina-
tion rates in voided urine collections in girls. J Pediatr
1989;114:91-3.
18. Unlu H, Sardan YC, Ulker S. Comparison of sampling meth-
ods for urine culture. J Nursing Scholarship 2007;39:325-9.
19. Geerlings SE, Brouwer EC, Gaastra W, Hoepelman AI. Is a
second urine specimen necessary for the diagnosis of asymp-
tomatic bacteriuria? CID 2000;31:3-4.
20. European Confederation of Laboratory Medicine.
European urinalysis guidelines: summary. Scand J Clin Lab
Invest 2000;60: 1-96.
21. Kampf G, Kramer A. Epidemiologic background of hand
hygiene and evaluation of the most important agents for
scrubs and rubs. Clin Microbial Rev 2004; 17:863-93.
22. World Health Organization. WHO Guidelines on hand
hygiene in health care. Global patient safety challenge
2005-2006: "Clean care is safer care". Geneva: WHO Press;
2006.
23. Aiello AE, Larson EL, Levy SB. Consumer antibacterial soaps:
effective or just risky? CID 2007;45 Suppl2:S137-47.
24. Hellerstein S. Urinary tract infections in children: why
they occur and how to prevent them. Am Fam Physician
1998;57:2440-6.
25. Franz M, Horl WH. Common errors in diagnosis and man-
agement of urinary tract infection. I: Pathophysiology and
diagnostic techniques. Nephrol Dial Transplant 1999;4:2 7 46-
53.
Published
2016-09-26
How to Cite
1.
Musim M, Damanik M, Suryantoro P. Effect of urethral meatus cleansing on midstream urine contamination rate in boys. PI [Internet]. 26Sep.2016 [cited 6May2024];48(3):180-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/529
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Received 2016-09-09
Accepted 2016-09-09
Published 2016-09-26
Accepted 2016-09-09
Published 2016-09-26
