What is the significance of urethral catheterization in the emergent management of pediatric patients with fever?

Updated: Jul 23, 2019
  • Author: Hina Z Ghory, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

In particular, clinicians should have a lower threshold for UTI screening for white girls; in 2 separate studies, UTI rates were as high as 17% in this group. [91, 92]

Urethral catheterization is the method of choice to obtain urine to avoid contamination with skin flora. Urine collected in a bag placed on the perineum is often contaminated and should not be evaluated for bacterial culture. [93, 94] Suprapubic aspiration of the bladder for urine should be discouraged. Urethral catheterization is less invasive and less painful and is associated with a higher yield of urine.

An enhanced UA, with a hemocytometer cell count and Gram stain of unspun urine, is more sensitive than a standard UA. [97] Since negative urine dipstick or UA results in febrile young children do not always exclude UTI, urine cultures should be performed regardless of UA results. [24, 89] In bacteremic children with UTI, blood cultures and urine cultures are likely to have identical organisms with identical antimicrobial sensitivities. [98]

A retrospective study by Shaikh et al that included 482 children younger than 6 years old with a first or second UTI found that renal scarring was associated with a delay in the initiation of antimicrobial therapy. 35 children (7.2%) developed new renal scaring and the median duration of fever before initiation of antibiotic therapy in the group with renal scaring was 72 hours compared to 48 hours in children with no renal scarring. [100, 101]


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