Rationale:
In a febrile child with symptoms and signs of a respiratory infection, the most likely diagnosis and cause of fever is the respiratory infection itself. Urine testing in this context can result in false-positive findings due to pyuria (which can occur with fever), asymptomatic bacteriuria, or sample contamination. Urine testing should only be considered if the child is septic, has underlying risk factors for urinary tract infection (UTI), or presents with specific urinary symptoms. It is essential to remember that respiratory infection may increase the likelihood of false-positive urine findings.
References:
- Ralston S, Hill V, Waters A. Occult Serious Bacterial Infection in Infants Younger Than 60 to 90 Days With Bronchiolitis: A Systematic Review. Arch Pediatr Adolesc Med. 2011; 165(10):951–6.
- Society CP. Urinary tract infection in infants and children: Diagnosis and management Canadian Paediatric Society
- Norsk Barnelegeforening. Urinveisinfeksjon. Akuttveileder i pediatri.
- Infants and children with an alternative site of infection should not have a urine sample tested. NICE guidelines. https://www.nice.org.uk/donotdo/infants-and-children-with-an-alternative-siteof-infection-should-not-have-a-urine-sample-tested
- Al-Orifi F, McGillivray D, Tange S, Kramer MS. Urine culture from bag specimens in young children: Are the risks too high? J Pediatr. 2000; 137(2):221–6.
- Tosif S, Baker A, Oakley E, et al. Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: An observational cohort study. J Paediatr Child Health. 2012; 48(8): 659–64.