Published online May 14, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1288-e1293 (doi:10.1542/peds.2006-2392)

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ARTICLE

To Clean or Not to Clean: Effect on Contamination Rates in Midstream Urine Collections in Toilet-Trained Children

Suzanne Vaillancourt, MD^a, David McGillivray, MD^a, Xun Zhang, PhD^b and Michael S. Kramer, MD^c

^a Division of Pediatric Emergency Medicine
^c Departments of Pediatrics and Epidemiology and Biostatistics, Montreal Children's Hospital
^b Montreal Children's Hospital Research Institute, McGill University, Montreal, Quebec, Canada

OBJECTIVE. Urinary tract infection is one of the most common bacterial infections among children. Difficulty in specimen collection and interpretation of inadequately collected specimens may contribute to misdiagnosis of urinary tract infection. Our objective was to assess the effect of perineal/genital cleaning on bacterial contamination rates of midstream urine collections in toilet-trained children.

METHODS. We conducted a randomized trial in toilet-trained children who presented to a tertiary care pediatric emergency department between November 1, 2004, and October 1, 2005. All toilet-trained children who were between the ages of 2 and 18 years and had a midstream urine sample requested were eligible. Those whose parents consented were cluster-randomized by week to either cleaning or not cleaning the perineum with soap. The risk for a contaminated urine culture (defined as growth of <10⁸ colony-forming units per liter [<10⁵ colony-forming units per milliliter] of a single organism or a mix of 2 organisms) and the risk for a positive urinalysis (defined as a positive leukocyte esterase and/or nitrites on dipstick or 5 white blood cells per high-powered field on a standard microscopic examination) were analyzed by intention to treat.

RESULTS. A total of 350 children were enrolled. The rate of contamination in the cleaning group was 14 (7.8%) of 179 vs 41 (23.9%) of 171 in the noncleaning group. Children who were randomly assigned to cleaning were less likely to have a positive urinalysis (37 of 179 [20.6%]) than those in the noncleaning group (63 of 171 [36.8%]).

CONCLUSIONS. Urine contamination rates are higher in midstream urine that is collected from toilet-trained children when obtained without perineal/genital cleaning. Cleaning may reduce the risk for returning for repeat cultures and for receiving unnecessary antibiotic treatment and investigations.

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Key Words: urinary tract infection • midstream clean catch • contamination rates

Abbreviations: UTI—urinary tract infection • ED—emergency department • CFU—colony-forming unit(s) • RR—relative risk • OR—odds ratio • CI—confidence interval • GLIMMIX—generalized linear matrix model

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Accepted Nov 21, 2006.

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