384 - Impact and relevance of a second urine culture by mid-stream in suspected urinary tract infection in children: A quality improvement study.

Poster Number: 384
Publication Number: 384.243

Céline Thémelin, Universite de Montreal Faculty of Medicine, Montréal, PQ, Canada; Emilie Vallieres, CHU Sainte-Justine, Montréal, PQ, Canada; Brigitte Parisien, CHU Ste-Justine, Montréal, PQ, Canada; Mélanie Labrosse, CHU ste-Justine, Montreal, PQ, Canada; Evelyne D.Trottier, CHU Sainte-Justine, Montreal, PQ, Canada

Background: In our emergency department (ED), 2 urine samples are routinely sent for culture, in suspicion of urinary tract infection (UTI), to facilitate interpretation if the 1st sample is contaminated. However, this practice is time and resource-consuming, for ED and microbiology laboratory.

Objective: To evaluate the relevance of a second mid-stream urine culture in suspected UTI in children.

Design/Methods: We retrospectively reviewed results of all urine culture from children collected in the ED of a tertiary care centre in 2017. When 2 urine samples per patient were collected, discordance was evaluated but also its impact on patient’s care.

Results: There was 2297 urine cultures identified. From those, 802 samples were excluded since only one culture was done leaving 1495 cultures for 729 patients. For 679/729 patients (93%), the control sample was similar, leaving 50 (7%) patients with a discordance (106 cultures). For 6 (1%) patients, the second urine culture was mandatory since the first urine sample was unsuitable (e.g. bag collection). For 38 patients (38/729[5%]), the second urine culture had no impact on the patient’s care. The second urine culture had an impact in 6 (1%) patients since the first one was negative and the second one had some bacterial growth (≤50 x106 CFU/L); all were treated with cephalosporins based on their urinalysis.Conclusion(s): In this study, a second urine culture was relevant in only 1% of patients with a minor impact. Therefore, routine collection of a second urine culture is resource consuming, futile and we recommend to stop it in our ED.