Is malodorous urine associated with urinary tract infection in children?

Although commonly reported by parents, the association of malodorous urine with confirmed urinary tract infection (UTI) in children remains controversial. In this two-year prospective study,1 the authors investigated whether parental reporting of malodorous urine was associated with confirmed UTI in children aged 1 to 36 months presenting with fever without focus. Of 331 children (median age 12 months), 51 (15%) had a confirmed UTI. The majority of urine specimens (88%) were obtained via catheter. Malodorous urine was reported in 57% (42–70) of children with confirmed UTI and 32% (42–70) of children without UTI. On regression analysis, children with malodorous urine were more likely to have a UTI (OR 2.83 (1.54–5.2)) compared to children without malodorous urine, even after adjustment for sex and the presence of reflux. Although malodorous urine is more likely in children with confirmed UTI results suggest that up to 40% of children with a UTI do not have malodorous urine and that as many as 30% of children with malodorous urine do not have a UTI. Therefore, we cannot definitively rule in or out a diagnosis of UTI based on urinary odour alone, but it may a useful sign to aid clinical decision-making in routine clinical practice.


Reviewers: William Renton ( and Tom Connell ( Royal Children's Hospital Melbourne.