Association of malodorous urine with urinary tract infection in children aged 1 to 36 months

Abstract

Objective: To determine whether parental reporting of malodorous urine is associated with urinary tract infection (UTI) in children.

Methods: We conducted a prospective consecutive cohort study in the emergency department of a pediatric hospital from July 31, 2009 to April 30, 2011. All children aged between 1 and 36 months for whom a urine culture was prescribed for suspected UTI (ie, unexplained fever, irritability, or vomiting) were assessed for eligibility. A standardized questionnaire was administered to the parents by a research assistant. The primary outcome measure was a UTI.

Results: Three hundred ninety-six children were initially enrolled, but 65 were excluded a posteriori either because a urine culture, although prescribed, was not done (11), was collected by bag (39), and/or showed gross contamination (25). Therefore, 331 children were included in the final analysis. Their median age was 12 months (range, 1-36). Criteria for UTI were fulfilled in 51 (15%). A malodorous urine was reported by parents in 57% of children with UTI and in 32% of children without UTI. On logistic regression, malodorous urine was associated with UTI (odds ratio 2.83, 95% confidence interval: 1.54-5.20). This association remained statistically significant when adjusted for gender and the presence of vesicoureteral reflux (odds ratio 2.73, 95% confidence interval: 1.46-5.08).

Conclusions: Parental reporting of malodorous urine increases the probability of UTI among young children being evaluated for suspected UTI. However, this association is not strong enough to definitely rule in or out a diagnosis of UTI.