Malodorous urine increases likelihood of UTI

When parents say their child's urine smells bad, physicians should test for a urinary tract infection, Canadian researchers report.

When parents say their child’s urine smells bad, physicians should test for a urinary tract infection, Canadian researchers report.

To examine the link between smelly urine and urinary tract infections, researchers from Sainte-Justine University Hospital Center at the University of Montreal surveyed the parents of 331 children ranging in age from 1 month to 3 years who were tested in the emergency room for a suspected UTI. The study was published online in Pediatrics (April 2, 2012).

Based on a questionnaire administered to parents, smelly urine was reported in 57% of the children with UTI and in 32% of children without UTI.

"On logistic regression, malodorous urine was associated with UTI," wrote the authors, led by Marie Gauthier, MD. "The association remained statistically significant when adjusted for sex and the presence of vesicoureteral reflux."

The investigators noted that the association between smelly urine and UTI was at least as significant as the association with female sex, past medical history of UTI, and presence of VUR. However, 40% of children with UTI in the series did not have malodorous urine, and 30% of parents reported malodorous urine in children without UTI.

Although parent report of smelly urine increased the probability of UTI, in particular in children with fever without source, it did not have a sufficiently high specificity or sensitivity to definitely rule in or rule out an infection.

Despite these limitations and given the clear association between this symptom and UTI, parental reporting of malodorous urine should make the clinician more suspicious of this type of infection in a young child with fever without source and ask for a urine culture more rapidly than if the child did not present with this symptom, according to the authors.

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