Potential conflicts of interest. Authors report the following.—research grants/contracts: Cangene Corporation, antibody responses to C. difficile –associated diarrhea; research with Virox Industries, HAI response to environmental disinfection.—advisory/consultant role: Cerena, Johnson & Johnson.—advisory/consultant role: InVentiv; honoraria: Health Research and Educational Trust/American Hospital Association, Rand Health.—served as a speaker for Bard; served as a speaker and author for Covidien.—honoraria and speaking fees for lectures on healthcare-associated infection prevention, implementation science, and patient safety from hospitals, academic medical centers, professional societies, and nonprofit foundations (none of these activities are related to speakers’ bureaus); medical advisory board: Doximity (a new social networking site for physicians), Jvion (a healthcare technology company)., ., ., ., .—nothing to disclose.
To make the diagnosis of a urinary tract infection in children, a positive urinary culture is required. Contamination poses a frequent challenge depending on the method of collection used, thus a cutoff of 10 5 CFU/mL is used for a "clean-catch" mid stream sample, 10 4 CFU/mL is used for catheter-obtained specimens, and 10 2 CFU/mL is used for suprapubic aspirations (a sample drawn directly from the bladder with a needle). The use of "urine bags" to collect samples is discouraged by the World Health Organization due to the high rate of contamination when cultured, and catheterization is preferred in those not toilet trained. Some, such as the American Academy of Pediatrics recommends renal ultrasound and voiding cystourethrogram (watching a person's urethra and urinary bladder with real time x-rays while they urinate) in all children less than two years old who have had a urinary tract infection. However, because there is a lack of effective treatment if problems are found, others such as the National Institute for Health and Care Excellence only recommends routine imaging in those less than six months old or who have unusual findings.