Urine Culture Results in Toddler with Multiple Comorbidities

Case at a Glance

A 16-month-old female with cerebral palsy, hypoglycemia, dairy allergy, GERD, and gastroparesis presenting with persistent irritability and behavioral changes following an episode of hyperglycemia.

Patient's Story

The patient's mother brought her 16-month-old daughter to the pediatrician due to several days of increased irritability and clingy behavior. The child, who has a complex medical history including cerebral palsy, hypoglycemia, dairy allergy, GERD, and gastroparesis, had been experiencing higher than normal blood glucose levels. The patient weighs 25 pounds and measures approximately 2.5 feet in length. She appeared significantly more distressed than usual, refusing to walk independently and requiring constant parental attention.

Initial Assessment

Initial evaluation revealed a distressed toddler with behavioral changes. Given her complex medical history and the presentation of hyperglycemia followed by persistent irritability, the pediatrician ordered comprehensive workup including urinalysis and blood work to rule out infectious causes.

The Diagnostic Journey

Initial blood work suggested possible viral infection but was otherwise unremarkable. A urine sample was collected using a bag collection method due to the patient's age and condition. The urinalysis showed presence of blood but no white blood cells. Urine culture results revealed: Coagulase negative Staphylococcus species (50,000-100,000 CFU/mL) and Enterococcus faecalis (10,000-25,000 CFU/mL).

Final Diagnosis

Contaminated urine specimen with uncertain clinical significance. The bag collection method and absence of pyuria make urinary tract infection unlikely despite bacterial growth.

Treatment Plan

Given the collection method and clinical presentation, the urine culture results were deemed likely contaminated. The healthcare team recommended clinical monitoring rather than antibiotic treatment. Further evaluation with catheterized urine sample was discussed if symptoms persist.

Outcome and Follow-up

Patient requires close follow-up to monitor symptom resolution. If irritability and behavioral changes persist, repeat urine culture via catheterization may be necessary. Additional imaging studies such as renal ultrasound may be considered if true UTI is confirmed, especially given the patient's complex medical history and potential for anatomical abnormalities.