DIAGNOSTIC VALUE OF SYMPTOMS AND CLEAN‐VOIDED URINE SPECIMEN IN CHILDHOOD URINARY TRACT INFECTION

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Abstract
In diagnosing urinary tract infection (UTI) the symptoms of 477 infants and children and the findings in their clean-voided urine specimens were evaluated. Of these, 322 patients were considered infected when a bacterial culture of suprapubic aspirate was used as a diagnostic reference. No diagnosis was attempted on the basis of symptoms only. Numerous bacteria or .gtoreq. 200 leuc./mm3 in an uncentrifuged clean-voided urine specimen or .gtoreq. 105 bact./ml in quantitative bacterial culture were found in 59%, 42% and 81% of the infected symptomatic patients. The diagnostic accuracies of these indices were 88%, 94% and 95%, respectively. In asymptomatic patients the accuracies were considerably lower. Among these infected patients normal or equivocal isolated findings in the clean-voided urine specimens were frequently seen, and could not markedly be reduced by the various related factors, such as technique of urine collection, urine specific gravity or pH or urine. None of the above mentioned indices of the clean-voided urine specimens seem accurate and sensitive enough individually for diagnosing UTI; these should be used in combination. The advantage of immediately obtaining results supports the use of urine microscopy as a primary diagnostic method in symptomatic UTI of childhood in particular.