Cystitis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Cystitis}} | {{Cystitis}} | ||
{{CMG}}{{SCC}}, {{USAMA}} | |||
==Overview== | |||
Presence of signs and symptoms of cystitis like [[dysuria]], [[nocturia]], [[frequency]] and [[urgency]] increase the probability of confirmation of [[cystitis]] as the diagnosis. Laboratory tests used in the diagnosis and confirmation of cystitis include [[urinalysis]] and [[urine culture]]. Laboratory findings consistent with the diagnosis of cystitis include [[pyuria]] and either [[white blood cell]]s (WBCs) or [[red blood cells]] (RBCs) on [[Urine|urinalysis]] and a positive [[urine culture]]. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
*A urine sample is required to do [[urinalysis]] and [[urine culture]] to look for the causative [[Organism|organisms]]. Careful collection is required to minimise the [[Pollution|contamination]] of the sample to decrease the [[Type I and type II errors|false positive]] results.<ref name="pmid18159059">{{cite journal| author=Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F et al.| title=Does this child have a urinary tract infection? | journal=JAMA | year= 2007 | volume= 298 | issue= 24 | pages= 2895-904 | pmid=18159059 | doi=10.1001/jama.298.24.2895 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159059 }} </ref> | |||
* Collection of urine from toilet trained children and adults by clean catch method is easy. Sample collection in children who are not toilet trained can be difficult and is achieved by either of these methods:<ref name="pmid27542848">{{cite journal| author=Labrosse M, Levy A, Autmizguine J, Gravel J| title=Evaluation of a New Strategy for Clean-Catch Urine in Infants. | journal=Pediatrics | year= 2016 | volume= 138 | issue= 3 | pages= | pmid=27542848 | doi=10.1542/peds.2016-0573 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27542848 }} </ref><ref name="pmid8304603">{{cite journal| author=Pollack CV, Pollack ES, Andrew ME| title=Suprapubic bladder aspiration versus urethral catheterization in ill infants: success, efficiency and complication rates. | journal=Ann Emerg Med | year= 1994 | volume= 23 | issue= 2 | pages= 225-30 | pmid=8304603 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8304603 }} </ref><ref name="pmid1903907">{{cite journal| author=Gochman RF, Karasic RB, Heller MB| title=Use of portable ultrasound to assist urine collection by suprapubic aspiration. | journal=Ann Emerg Med | year= 1991 | volume= 20 | issue= 6 | pages= 631-5 | pmid=1903907 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1903907 }} </ref> | |||
**Suprapubic aspiration (up to 80% success rate when done with [[Medical ultrasonography|ultrasonography]]) | |||
**Urethral [[catheterization]] | |||
**Clean catch collection from [[urine]] bag | |||
Of all these methods suprapubic aspiration has the least contamination rate that is around 1%, while that for transurethral [[catheterization]] has 6-12% and clean catch urine collected in a bag can have the highest contamination rate of 16-63%.<ref name="pmid27542848">{{cite journal| author=Labrosse M, Levy A, Autmizguine J, Gravel J| title=Evaluation of a New Strategy for Clean-Catch Urine in Infants. | journal=Pediatrics | year= 2016 | volume= 138 | issue= 3 | pages= | pmid=27542848 | doi=10.1542/peds.2016-0573 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27542848 }} </ref><ref name="pmid22537082">{{cite journal| author=Tosif S, Baker A, Oakley E, Donath S, Babl FE| title=Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: an observational cohort study. | journal=J Paediatr Child Health | year= 2012 | volume= 48 | issue= 8 | pages= 659-64 | pmid=22537082 | doi=10.1111/j.1440-1754.2012.02449.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22537082 }} </ref><ref name="pmid10931415">{{cite journal| author=Al-Orifi F, McGillivray D, Tange S, Kramer MS| title=Urine culture from bag specimens in young children: are the risks too high? | journal=J Pediatr | year= 2000 | volume= 137 | issue= 2 | pages= 221-6 | pmid=10931415 | doi=10.1067/mpd.2000.107466 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10931415 }} </ref> With any technique the rate of contamination can be decreased by discarding the initial stream of [[urine]] and collecting and using the middle stream of [[urine]] so that the [[bacteria]] already present on the [[skin]] or the catheter do not affect the results.<ref name="pmid21873693">{{cite journal| author=Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Roberts KB| title=Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. | journal=Pediatrics | year= 2011 | volume= 128 | issue= 3 | pages= 595-610 | pmid=21873693 | doi=10.1542/peds.2011-1330 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21873693 }} </ref><ref name="pmid10784208">{{cite journal| author=Dayan PS, Chamberlain JM, Boenning D, Adirim T, Schor JA, Klein BL| title=A comparison of the initial to the later stream urine in children catheterized to evaluate for a urinary tract infection. | journal=Pediatr Emerg Care | year= 2000 | volume= 16 | issue= 2 | pages= 88-90 | pmid=10784208 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10784208 }} </ref> | |||
===Urine Sample Collection=== | |||
Many aspects have to be taken care of while collecting a urine sample. The technique for urine sample collection is as follows:<ref name="pmid27542848">{{cite journal| author=Labrosse M, Levy A, Autmizguine J, Gravel J| title=Evaluation of a New Strategy for Clean-Catch Urine in Infants. | journal=Pediatrics | year= 2016 | volume= 138 | issue= 3 | pages= | pmid=27542848 | doi=10.1542/peds.2016-0573 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27542848 }} </ref><ref name="pmid17502345">{{cite journal| author=Vaillancourt S, McGillivray D, Zhang X, Kramer MS| title=To clean or not to clean: effect on contamination rates in midstream urine collections in toilet-trained children. | journal=Pediatrics | year= 2007 | volume= 119 | issue= 6 | pages= e1288-93 | pmid=17502345 | doi=10.1542/peds.2006-2392 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17502345 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18063738 Review in: Evid Based Med. 2007 Dec;12(6):178] [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18192530 Review in: Evid Based Nurs. 2008 Jan;11(1):25] </ref> | |||
* The perineal area must be cleansed with an [[antiseptic]] or soap in young male or female children. | |||
* Retraction of [[foreskin]] may be required if not circumcised. | |||
* The patient must urinate in a toilet. | |||
* The initial [[urine]] stream must not be collected. | |||
* The midstream of [[urine]] is collected in a wide mouth bottle or container. | |||
* For infants less than 6 months:<ref name="pmid27542848">{{cite journal| author=Labrosse M, Levy A, Autmizguine J, Gravel J| title=Evaluation of a New Strategy for Clean-Catch Urine in Infants. | journal=Pediatrics | year= 2016 | volume= 138 | issue= 3 | pages= | pmid=27542848 | doi=10.1542/peds.2016-0573 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27542848 }} </ref><ref name="pmid23172785">{{cite journal| author=Herreros Fernández ML, González Merino N, Tagarro García A, Pérez Seoane B, de la Serna Martínez M, Contreras Abad MT et al.| title=A new technique for fast and safe collection of urine in newborns. | journal=Arch Dis Child | year= 2013 | volume= 98 | issue= 1 | pages= 27-9 | pmid=23172785 | doi=10.1136/archdischild-2012-301872 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23172785 }} </ref> | |||
**One assistant holds the infant and the other holds the cup or container to collect the [[urine]]. | |||
**[[Urinary bladder|Bladder]] massage is done by tapping on the [[Urinary bladder|bladder]] for 30 seconds at a pace of 100/minute. | |||
**[[Urinary bladder|Bladder]] Massage is followed by paravertebral massage until [[urination]] occurs. | |||
* For [[infants]] and [[children]] more than 6 months old, a [[urine]] bag can be applied and removed after [[urine]] collection. | |||
The sample collected must be sent to the lab as soon as possible since the warm temperature of the [[urine]] facilitates growth of [[pathogen]] and thus can lead to a falsely high count. An early report is helpful with initiating specific treatment. Storage at 4 degrees may be required if the sample can not be examined immediately.<ref name="pmid11729209">{{cite journal| author=Graham JC, Galloway A| title=ACP Best Practice No 167: the laboratory diagnosis of urinary tract infection. | journal=J Clin Pathol | year= 2001 | volume= 54 | issue= 12 | pages= 911-9 | pmid=11729209 | doi= | pmc=1731340 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11729209 }} </ref> | |||
===Urinalysis=== | ===Urinalysis=== | ||
* A [[urinalysis]] commonly reveals white blood | Presence of [[nitrites]] or [[leukocyte esterase]] on dipstick or presence of [[WBC|WBCs]] of [[bacteria]] on microscopic examination suggests the presence of a [[urinary tract infection]].<ref name="pmid11791090">{{cite journal| author=Huicho L, Campos-Sanchez M, Alamo C| title=Metaanalysis of urine screening tests for determining the risk of urinary tract infection in children. | journal=Pediatr Infect Dis J | year= 2002 | volume= 21 | issue= 1 | pages= 1-11, 88 | pmid=11791090 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11791090 }} </ref><ref name="pmid10545580">{{cite journal| author=Gorelick MH, Shaw KN| title=Screening tests for urinary tract infection in children: A meta-analysis. | journal=Pediatrics | year= 1999 | volume= 104 | issue= 5 | pages= e54 | pmid=10545580 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10545580 }} </ref><ref name="pmid8123075">{{cite journal| author=Hoberman A, Wald ER, Penchansky L, Reynolds EA, Young S| title=Enhanced urinalysis as a screening test for urinary tract infection. | journal=Pediatrics | year= 1993 | volume= 91 | issue= 6 | pages= 1196-9 | pmid=8123075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8123075 }} </ref> | ||
*[[Pyuria]]: >5-10 WBC/hpf or 27 WBC/ | |||
*A [[urinalysis]] commonly reveals [[white blood cell]]s ([[WBC]]<nowiki/>s) or [[red blood cells]] ([[RBC]]<nowiki/>s). | |||
*[[Pyuria]]: > 5-10 WBC/hpf or 27 [[WBC]]/microliter | |||
*Dipstick: | *Dipstick: | ||
**[[Nitrate reductase test]] | **[[Nitrate reductase test]] is used to differentiate between [[bacteria]] based on their ability or inability to reduce [[nitrate]] (NO<sub>3</sub>) to [[nitrite]] (NO<sub>2</sub>) using [[anaerobic respiration]]. | ||
** [[Leukocyte esterase]] | ** [[Leukocyte esterase]] is a urine test for the presence of [[white blood cell]]s and other abnormalities associated with [[infection]]. | ||
===Urine Culture=== | ===Urine Culture=== | ||
* A [[urine culture]] (clean catch) or catheterized urine specimen may be performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment. | * [[Urine culture]] is done to identify the particular [[pathogen]], so that the specific treatment can be given.<ref name="pmid13380946">{{cite journal| author=KASS EH| title=Asymptomatic infections of the urinary tract. | journal=Trans Assoc Am Physicians | year= 1956 | volume= 69 | issue= | pages= 56-64 | pmid=13380946 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13380946 }} </ref> | ||
* Most patients with [[ | |||
====Bacterial Culture==== | |||
* A [[urine culture]] (clean catch) or catheterized urine specimen may be performed to determine the type of [[bacteria]] in the [[urine]] and the appropriate [[antibiotic]] for treatment. | |||
* Most patients with [[urinary tract infection]] will have > 100,000 colonies of organism (CFU/mL). | |||
====Viral Culture==== | |||
* The viruses involved in causing cystitis include [[HIV]], [[adenovirus|''adenovirus'']], [[cytomegalovirus|''cytomegalovirus'']] and [[Polyomavirus|''polyoma'' viruses]]. Viral cultures are only done in [[immunocompromised]] individuals or in those patients in whom the [[Urine|urinalysis]] and [[bacterial cultures]] are negative despite symptoms.<ref name="pmid15723924">{{cite journal| author=Allen CW, Alexander SI| title=Adenovirus associated haematuria. | journal=Arch Dis Child | year= 2005 | volume= 90 | issue= 3 | pages= 305-6 | pmid=15723924 | doi=10.1136/adc.2003.037952 | pmc=1720282 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15723924 }} </ref> | |||
====Fungal Culture==== | |||
* [[Candida]] is the most common [[fungus]] associated with fungal cystitis. Fungal cystitis is a rare when compared with bacteria cystitis. It can cause cystitis in [[Immunodeficiency|immunocompromised]] patients only and presence of [[fungus]] in the [[urine]] is sometimes evaluated in hospitalised patients.<ref name="pmid10619726">{{cite journal| author=Kauffman CA, Vazquez JA, Sobel JD, Gallis HA, McKinsey DS, Karchmer AW et al.| title=Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. | journal=Clin Infect Dis | year= 2000 | volume= 30 | issue= 1 | pages= 14-8 | pmid=10619726 | doi=10.1086/313583 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10619726 }}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
[[Category: | {{WS}} | ||
[[Category:Medicine]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category: | [[Category:Nephrology]] | ||
[[Category:Urology]] | |||
[[Category:Up-To-Date]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Steven C. Campbell, M.D., Ph.D., Usama Talib, BSc, MD [2]
Overview
Presence of signs and symptoms of cystitis like dysuria, nocturia, frequency and urgency increase the probability of confirmation of cystitis as the diagnosis. Laboratory tests used in the diagnosis and confirmation of cystitis include urinalysis and urine culture. Laboratory findings consistent with the diagnosis of cystitis include pyuria and either white blood cells (WBCs) or red blood cells (RBCs) on urinalysis and a positive urine culture.
Laboratory Findings
- A urine sample is required to do urinalysis and urine culture to look for the causative organisms. Careful collection is required to minimise the contamination of the sample to decrease the false positive results.[1]
- Collection of urine from toilet trained children and adults by clean catch method is easy. Sample collection in children who are not toilet trained can be difficult and is achieved by either of these methods:[2][3][4]
- Suprapubic aspiration (up to 80% success rate when done with ultrasonography)
- Urethral catheterization
- Clean catch collection from urine bag
Of all these methods suprapubic aspiration has the least contamination rate that is around 1%, while that for transurethral catheterization has 6-12% and clean catch urine collected in a bag can have the highest contamination rate of 16-63%.[2][5][6] With any technique the rate of contamination can be decreased by discarding the initial stream of urine and collecting and using the middle stream of urine so that the bacteria already present on the skin or the catheter do not affect the results.[7][8]
Urine Sample Collection
Many aspects have to be taken care of while collecting a urine sample. The technique for urine sample collection is as follows:[2][9]
- The perineal area must be cleansed with an antiseptic or soap in young male or female children.
- Retraction of foreskin may be required if not circumcised.
- The patient must urinate in a toilet.
- The initial urine stream must not be collected.
- The midstream of urine is collected in a wide mouth bottle or container.
- For infants less than 6 months:[2][10]
- For infants and children more than 6 months old, a urine bag can be applied and removed after urine collection.
The sample collected must be sent to the lab as soon as possible since the warm temperature of the urine facilitates growth of pathogen and thus can lead to a falsely high count. An early report is helpful with initiating specific treatment. Storage at 4 degrees may be required if the sample can not be examined immediately.[11]
Urinalysis
Presence of nitrites or leukocyte esterase on dipstick or presence of WBCs of bacteria on microscopic examination suggests the presence of a urinary tract infection.[12][13][14]
- A urinalysis commonly reveals white blood cells (WBCs) or red blood cells (RBCs).
- Pyuria: > 5-10 WBC/hpf or 27 WBC/microliter
- Dipstick:
- Nitrate reductase test is used to differentiate between bacteria based on their ability or inability to reduce nitrate (NO3) to nitrite (NO2) using anaerobic respiration.
- Leukocyte esterase is a urine test for the presence of white blood cells and other abnormalities associated with infection.
Urine Culture
- Urine culture is done to identify the particular pathogen, so that the specific treatment can be given.[15]
Bacterial Culture
- A urine culture (clean catch) or catheterized urine specimen may be performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment.
- Most patients with urinary tract infection will have > 100,000 colonies of organism (CFU/mL).
Viral Culture
- The viruses involved in causing cystitis include HIV, adenovirus, cytomegalovirus and polyoma viruses. Viral cultures are only done in immunocompromised individuals or in those patients in whom the urinalysis and bacterial cultures are negative despite symptoms.[16]
Fungal Culture
- Candida is the most common fungus associated with fungal cystitis. Fungal cystitis is a rare when compared with bacteria cystitis. It can cause cystitis in immunocompromised patients only and presence of fungus in the urine is sometimes evaluated in hospitalised patients.[17]
References
- ↑ Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F; et al. (2007). "Does this child have a urinary tract infection?". JAMA. 298 (24): 2895–904. doi:10.1001/jama.298.24.2895. PMID 18159059.
- ↑ 2.0 2.1 2.2 2.3 Labrosse M, Levy A, Autmizguine J, Gravel J (2016). "Evaluation of a New Strategy for Clean-Catch Urine in Infants". Pediatrics. 138 (3). doi:10.1542/peds.2016-0573. PMID 27542848.
- ↑ Pollack CV, Pollack ES, Andrew ME (1994). "Suprapubic bladder aspiration versus urethral catheterization in ill infants: success, efficiency and complication rates". Ann Emerg Med. 23 (2): 225–30. PMID 8304603.
- ↑ Gochman RF, Karasic RB, Heller MB (1991). "Use of portable ultrasound to assist urine collection by suprapubic aspiration". Ann Emerg Med. 20 (6): 631–5. PMID 1903907.
- ↑ Tosif S, Baker A, Oakley E, Donath S, Babl FE (2012). "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. 48 (8): 659–64. doi:10.1111/j.1440-1754.2012.02449.x. PMID 22537082.
- ↑ Al-Orifi F, McGillivray D, Tange S, Kramer MS (2000). "Urine culture from bag specimens in young children: are the risks too high?". J Pediatr. 137 (2): 221–6. doi:10.1067/mpd.2000.107466. PMID 10931415.
- ↑ Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Roberts KB (2011). "Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months". Pediatrics. 128 (3): 595–610. doi:10.1542/peds.2011-1330. PMID 21873693.
- ↑ Dayan PS, Chamberlain JM, Boenning D, Adirim T, Schor JA, Klein BL (2000). "A comparison of the initial to the later stream urine in children catheterized to evaluate for a urinary tract infection". Pediatr Emerg Care. 16 (2): 88–90. PMID 10784208.
- ↑ Vaillancourt S, McGillivray D, Zhang X, Kramer MS (2007). "To clean or not to clean: effect on contamination rates in midstream urine collections in toilet-trained children". Pediatrics. 119 (6): e1288–93. doi:10.1542/peds.2006-2392. PMID 17502345. Review in: Evid Based Med. 2007 Dec;12(6):178 Review in: Evid Based Nurs. 2008 Jan;11(1):25
- ↑ Herreros Fernández ML, González Merino N, Tagarro García A, Pérez Seoane B, de la Serna Martínez M, Contreras Abad MT; et al. (2013). "A new technique for fast and safe collection of urine in newborns". Arch Dis Child. 98 (1): 27–9. doi:10.1136/archdischild-2012-301872. PMID 23172785.
- ↑ Graham JC, Galloway A (2001). "ACP Best Practice No 167: the laboratory diagnosis of urinary tract infection". J Clin Pathol. 54 (12): 911–9. PMC 1731340. PMID 11729209.
- ↑ Huicho L, Campos-Sanchez M, Alamo C (2002). "Metaanalysis of urine screening tests for determining the risk of urinary tract infection in children". Pediatr Infect Dis J. 21 (1): 1–11, 88. PMID 11791090.
- ↑ Gorelick MH, Shaw KN (1999). "Screening tests for urinary tract infection in children: A meta-analysis". Pediatrics. 104 (5): e54. PMID 10545580.
- ↑ Hoberman A, Wald ER, Penchansky L, Reynolds EA, Young S (1993). "Enhanced urinalysis as a screening test for urinary tract infection". Pediatrics. 91 (6): 1196–9. PMID 8123075.
- ↑ KASS EH (1956). "Asymptomatic infections of the urinary tract". Trans Assoc Am Physicians. 69: 56–64. PMID 13380946.
- ↑ Allen CW, Alexander SI (2005). "Adenovirus associated haematuria". Arch Dis Child. 90 (3): 305–6. doi:10.1136/adc.2003.037952. PMC 1720282. PMID 15723924.
- ↑ Kauffman CA, Vazquez JA, Sobel JD, Gallis HA, McKinsey DS, Karchmer AW; et al. (2000). "Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group". Clin Infect Dis. 30 (1): 14–8. doi:10.1086/313583. PMID 10619726.