Table 1

Details of tests evaluated in the review

Test

Details

Advantages

Disadvantages


Urine sampling


Suprapubic aspiration (SPA)

Needle attached to syringe inserted through lower abdomen into bladder.

Least risk of contamination

Invasive

Transurethral catheterisation

Catheter inserted through the urethra into the bladder.

Less invasive than SPA

Invasive, causes pain and distress to child

Clean voided urine (CVU)

Midstream sample collected in sterile container.

Non-invasive, easy to obtain

Difficult in younger children

Urine bags

Bag applied to perineum.

Suitable for babies and infants

Risk of contamination

Urine pads

Absorbent pad placed in nappy.


Dipstick


Nitrite

Gram-negative bacteria reduce dietary nitrate to nitrites.

Very easy and quick to perform, relatively cheap

Less accurate than culture

Leukocyte esterase (LE) Glucose

Leukocyte esterase is an enzyme that suggests the presence of leukocytes. Normal urine contains small amount of glucose. Bacteria metabolise glucose and so this test tests for the absence of glucose. Requires morning fasting urine specimen.

Not commercially available, not suitable for non-potty trained children


Microscopy


Pyuria

Urine examined through microscope for presence of white blood cells. Samples may be centrifuged before examination

Quicker than culture

More time consuming than dipstick, more expensive than dipstick and culture

Bacteriuria

Urine examined for presence of bacteria.

Urine may be Gram-stained.


Culture


Standard Culture

Reference standard test for UTI. Involves streaking urine on enrichment and selective media.

Very accurate

Time consuming: takes 48 hours to give a result, has to be performed in the laboratory


Whiting et al. BMC Pediatrics 2005 5:4   doi:10.1186/1471-2431-5-4

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