Midazolam for urethral catheterisation in female infants with suspected urinary tract infection: a case-control study

• Published in: Emergency medicine journal : EMJ Vol. 31; no. 4; pp. 278 - 280
• Main Authors: Shavit, Itai, Feraru, Liat, Miron, Dan, Weiser, Giora
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2014
• Subjects: Age; Anesthesia; Anesthetics, Intravenous - therapeutic use; Bacteria; Bacteria - isolation & purification; Bacterial infections; Caregivers; Case-Control Studies; Demographics; Emergency Service, Hospital - statistics & numerical data; Female; Females; Humans; Infant; Length of Stay - statistics & numerical data; Midazolam - therapeutic use; Pain - prevention & control; Retrospective Studies; Studies; Urinary Catheterization - adverse effects; Urinary Catheterization - methods; Urinary tract diseases; Urinary Tract Infections - diagnosis; Urinary Tract Infections - microbiology; Urine; Urine - microbiology; Urogenital system; paediatrics, paediatric emergency medicine; analgesia/pain control
• ISSN: 1472-0205; 1472-0213; 1472-0213
• DOI: 10.1136/emermed-2012-202088

Objectives Based on the 2010 Israeli Medical Association recommendations, young children with suspected urinary tract infection (UTI) are mildly sedated with oral or intranasal midazolam to reduce the distress associated with urethral catheterisation (UC). The primary objective of this study was to examine the rate of urine culture contamination (UCC) in infants who underwent UC with and without sedation. Other objectives were to evaluate serious adverse events and emergency department (ED) length of stay. Methods A retrospective case-control study was conducted in a paediatric ED. Results Two cohorts of patients who underwent UC were compared, 164 female infants who were sedated with midazolam (case subjects) and 173 who were not (controls). Cases and controls had a mean temperature of 38.3°C and 38.2°C, respectively. One hundred and forty-one patients were treated with oral midazolam and 23 received the drug intranasally. Cases and controls had a UCC rate of 20/164 (12%) and 45/173 (26%), respectively. Compared with controls, cases had lower odds of UCC (OR=0.39, 95% CI 0.21 to 0.73).Serious adverse events related to midazolam were not recorded. Case subjects and controls had a mean ED length of stay of 2.96 h and 2.50 h, respectively. The difference between the groups was statistically significant (p<0.014, 95% CI 0.10 to 0.90 for difference between means). Conclusions In this cohort of febrile infants, sedation with oral or intranasal midazolam reduced the risk of culture contamination during UC without causing serious adverse events. However, patients who were treated with sedation had longer length of stay in the ED.