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You could also read the letter we just published in Clin Pediatr (Phila) on SPA vs BAGs.


   Grisaru-Soen G, Goldman R, Barzilai A, Lotan D, Keller N.
   False-positive urine cultures using bag collection.
   Clin Pediatr (Phila). 2000 Aug;39(8):499-500.



Ran D. Goldman, MD
Fellow
Pediatric Emergency Medicine
The Hospital for Sick Children
Toronto, ON
Canada

---- Begin Original Message ----
From: Jay Pershad <[log in to unmask]>
Sent: Wed, 6 Sep 2000 16:26:38 -0500
To: [log in to unmask]
Subject: Re: Urine samples in children

David:
If the test was normal, i.e. cultures were negative, you just proved your
point! However, I believe you were just lucky!! The higher odds of
contamination and false positives with bag specimens make it an unreliable
method of collection. The interpretation of a positive culture then becomes
an issue that the pediatrician and the family have to endure. The latter
includes recall for repeat UC (by catheterization or SPU),  additional time
and expenditure and last but not the least, added stress for the family. It
is easier to obtain a catheter sample upfront if you are really concerned
about a UTI as the source of the fever.  Alternatively, if you desire 100%
specificity, a supra-pubic sample  is the way to go. Any growth on a SPU is
a true positive. The heart of the issue is that reliable diagnosis of UTI in
infancy is important, given its implications.

Reference:
Urine culture from bag specimens in young children: Are the risks too high?
J Pediatr. 2000 Aug;137(2):221-226.
Al-Orifi F, McGillivray D, Tange S, Kramer MS.

Hope that helps.
Jay
Jay Pershad, MD
Pediatric Emergency Specialists, PC
LeBonheur Children's Medical Center
Memphis, TN








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