The Case

The emergency department is getting busier with the after-work and after-school crowds. The next patient is a 5-month-old boy brought in by his parents because of a fever. The fever started that morning, and they kept him home from day care. The infant is immunized, looks well, and is drinking fluids in the department. Your examination does not indicate a source of infection. A urinary tract infection (UTI) is a possibility, but you know it could take a long time to get a noninvasive urine sample. In addition, bagged samples can often be falsely positive, and then you would need to get a urine sample using an invasive method such as a catheter. Could there be a way to increase the chance of getting a clean catch urine in fewer than five minutes?

Background

Urine samples are frequently required to rule in or rule out UTIs in children presenting to the emergency department with vomiting, fever, abdominal pain, and/or nonspecific illnesses.

The American Academy of Pediatrics (AAP) states that the diagnosis of a UTI requires a urinalysis and a urine culture. This comes from its 2016 clinical practice guidelines for the diagnosis and management of UTIs that reaffirmed earlier recommendations.¹

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