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I welcomed Shaikh’s article about acute urinary tract infection in infants and young children.1 Fever of unknown origin is a frequent issue in family practice, and confidence in excluding this diagnosis is helpful for both practitioner and parent.
I was puzzled, however, at the description of the necessity of urine test cultures. Shaikh states that a bag urine specimen is helpful if the results are negative, yet he goes on to quote a 12% false-negative rate and a requirement that “all urine specimens should be sent for culture.” My teaching was always that it is not appropriate to send a bag urine specimen for culture owing to contamination.
My question is this: Is it useful to obtain a bag urine specimen rather than a catheter specimen if a culture is always necessary to avoid a false-negative result? Is Shaikh suggesting that a bag specimen should be sent for culture? This is highly relevant in my office, where we can readily obtain a bag urine specimen but have to refer a patient to the local hospital for a catheter specimen.
For the full letter, go to: www.cmaj.ca/cgi/eletters/182/8/800#593791