Diagnosis Of UTI in A 12 Month Old Child.

Which of the following are diagnostic of urinary tract infection in a 12-month-old child?
A. A bag specimen that grows 50,000 bacterial colonies
B. Transurethral catheter specimen with 5,000 bacterial colonies
C. A suprapubic aspirate specimen with 1,000 bacterial colonies
D. A bag specimen with 10 to 15 WBCs per high-powered field
E. A bag specimen positive for nitrite and/or leukocyte esterase

Answer:  C (A suprapubic aspirate specimen with 1,000 bacterial colonies)

Discussion: Urinary tract infection (UTI) must be considered in the differential of any febrile child without an apparent source of infection. When evaluating young children for possible UTI, proper specimen collection is critical to obtaining reliable and meaningful results on which to diagnose and treat the child. Acceptable methods for urine collection in children unable to provide clean catch specimens include transurethral catheterization and suprapubic aspiration. Bag specimens are reassuring only if negative and cannot be relied on for accurate urinalysis or cultures. Definitions of positive cultures depend on the method of collection. Catheter specimens with greater than 100,000 bacterial colonies and suprapubic aspirates with any colony count are considered positive and should be treated.