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1.  All urine specimens for culture in children under 2 years of age
should
be collected by catheter or suprapubic tap.
 
I think it is reasonable to culture a clean catch urine from a child of
any age as long as the perineum is well cleaned and the specimen
container is passed into a good, ideally arcing, stream and if an urgent
microscopy is negative for squamous epithelial cells. After all, isn't
this the principle of an MSU in an older, cooperative child? Of course,
this is easier said than done and I offer the alternative of an SPA or
CSU to the parents, an offer yet to be accepted. Of course if the child
was unwell enough to warrant immediate antibiotics then a more
aggressive and invasive approach of immediate SPA or CSU would be
reasonable.
 
2.  In children being worked up for a possible occult urinary tract
infection, bag specimens are only possibly helpful if the UA is negative
and
culture grows less than 100,000 colonies of a single organism.
 
  In my experience bag specimens are highly prone to contamination and
are less than useless. A lot of time is wasted waiting for a culture
result which dictates a repeat specimen and further delay. I restrict
the use of a bag to metabolic investigations, checking specific gravity,
ketones and glucose and very occasionally when the family is distraught
and have missed a couple of clean catches and this is the best we'll get
today.
 
3.  Any child under 2 years old with a fever of undetermined etiology
should
have a urine culture sent regardless of the UA or dip urine result.
 
  Agreed. Negative UA or dip or microscopy for that matter does not
exclude a UTI.
 
5.  A healthy appearing fully immunized.....
 
Agreed. Always needs a urine culture which in a pinch can be obtained at
home. (social situation appropriate)
 
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