Despite having a simple solution for detecting urinary tract infections (UTIs) in adults for decades, finding a similarly reliable test in pediatric patients has been a matter of debate for nearly as long. Fortunately, researchers in our Division of General Academic Pediatrics (GAP), have published new findings about the accuracy of urine culture at various levels, weighing the balance between sensitivity and sensitivity in suspected UTIs in pediatric patients undergoing bladder catheterization. 
Published in Pediatrics, and titled “Support for the Use of a New Cutoff to Define a Positive Urine Culture in Young Children,” this groundbreaking work is decades in the making. The primary author of the work is Nader Shaikh, MD, MPH, Professor of Pediatrics and Clinical and Translational Science, and includes contributing authors Sojin Lee, PhD and Marcia Kurs-Lasky, MS, all of our GAP division.
Thanks to the advent of new testing techniques, Shaikh et al were able to determine that the use of 16S ribosomal ribonucleic acid (rRNA) gene amplicon sequencing as the reference standard when assessing the accuracy of conventional urine culture was successful when diagnosing UTIs.
Using the 16S rRNA gene amplicon sequencing as a standard, the research team calculated the accuracy of conventional urine cultures at various cutoffs (10,000, 50,000, and 100,000 colony forming units per milliliter) and looked at febrile children from 1 month to 3 years of age that underwent bladder catheterization for a suspected UTI. Ultimately, while the specificity of urine culture remained relatively unchanged across the various cutoff points, the sensitivity was highest at the 10,000 CFU/mL cutoff, and only decreased among the higher levels.
Study conclusions indicated that while conventional culture remains an accurate method of diagnosing UTIs in young children, data suggests a cutoff of 10,000 CFU/mL provides an optimal balance between sensitivity and specificity in pediatric bladder catheterizations.
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