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Malodorous urine not necessarily a sign of UTI
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While parental reporting of malodorous urine is often indicative of urinary tract infection in young children, this is not a definitive marker of the infection, according to a recently published study.
Marie Gauthier, MD, and colleagues from the department of pediatrics at Sainte-Justine University Hospital Center at the University of Montreal in Canada performed a prospective, consecutive cohort study on 331 children from July 31, 2009, to April 30, 2011, who were prescribed a urine culture for a suspected urinary tract infection (UTI).
The researchers administered a standardized questionnaire to parents. Gauthier and colleagues reported that about 15% of children were confirmed for UTI. Of these 51 UTI cases, 57% were reported to have had malodorous urine by a parent. However, 32% of the 280 children who did not have a UTI also were reported to have malodorous urine. While there was a statistically significant association between malodorous urine and UTI, even when accounting for gender and the presence of vesicoureteral reflux, the association is not strong enough to stand alone as a means of diagnosis, the researchers wrote.
“Although parental reporting of malodorous urine increased the probability of UTI, in particular, in children with fever without source (FWS), it did not have a sufficiently high specificity or sensitivity to definitely rule in or rule out a UTI,” the study authors wrote.
Despite these limitations, and given the clear association between this symptom and UTI, reporting of malodorous urine by parents should make the clinician more suspicious of this type of infection in a young child with FWS.”
Disclosure: Dr. Gauthier reports no relevant financial disclosures. This study was supported by the Fonds d’opération pour les projets de recherche clinique appliquée, CHU Sainte-Justine, Montreal.
Perspective
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Alejandro Hoberman, MD
The study showed that, in children aged 1 to 36 months for whom a urine specimen was obtained to rule out UTI (unexplained fever, irritability or vomiting), the presence of malodorous urine was more likely to be reported by parents of children with UTI vs those with negative urine cultures (57% vs. 32%). Demographic and clinical characteristics of the population studied are consistent with previous studies assessing the risk for UTI in young children. Methods of urine collection, particularly the fact that almost 90% of specimens were collected by bladder catheterization, with the remaining being clean voided specimens and suprapubic aspiration, seem appropriate. So were criteria used for considering a urine culture positive. Of the 331 children included in the analysis, 51 (15%) had UTI and 57% of parents reported malodorous urine. In contrast, only 32% of parents of children whose urine culture was negative reported malodorous urine.
The authors concluded that although parental report of malodorous urine should make the clinician more suspicious about UTI, particularly in young children with fever without a source, this symptom does not exhibit sufficiently high specificity or sensitivity to rule in or out a UTI diagnosis.
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