American Academy of Pediatrics Section on Urology

View all recommendations from this society

Released January 4, 2022

Do not perform a bagged urine specimen for urine culture to confirm urinary tract infection in a non-potty-trained child.

Prospective studies on the use of a bag applied to the perineum for urine collection have shown a high incidence of false-positive culture results, ranging from 85 – 99%. Bagged specimens, when collected appropriately, may be used for screening urinalysis as a first step when a urinary tract infection is suspected. If there are signs of infection, a properly collected urine culture should then be obtained. For children under 2 years of age, it is recommended to perform sterile-technique urethral catheterization. Alternatively, suprapubic bladder aspiration has been shown to have the highest sensitivity but requires skilled providers often with ultrasound guidance, so is often not practical. In older children with sphincteric control, mid-stream clean-catch collection is possible and reliable. AAP, American Academy of Family Physicians (AAFP), and European Association of Urology (EAU) guidelines each issue this recommendation with the support of quality A evidence.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The AAP Section on Urology (AAP SOU) Executive committee worked together to develop five items in the practice of Pediatric Urology of tests or procedures that should not be done routinely. Approximately 11 members of this committee participated in the process. They submitted items from their practices and experiences of tests or procedures they found were commonly over-utilized. The committee then agreed on a final list of 5 based on incidence and importance of the condition. Educational committee fellows then reviewed the appropriate guidelines and literature to provide references and support for each item. The AAP SOU Education committee reviewed the 5 listed items and provided further feedback then approved the list, descriptions, and references. The AAP Executive Committee granted final approval of the list.

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Grabe M, Bartoletti R, Bjerklund Johansen TE, et al: European Association of Urology: Guidelines on Urological Infections. 2015 March.

Koch VH, Zuccolotto SMC: Urinary tract infection: a search for evidence. J Pediatr (Rio J) 2003 79(1): S97-S106.