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Forster CS, Miller RG, Gibeau A, Meyer T, Kamanzi S, Shaikh N, Chu DI. Accuracy of Urinalysis for UTI in Spina Bifida. Pediatrics 2024; 154:e2023065192. [PMID: 38845550 PMCID: PMC11211690 DOI: 10.1542/peds.2023-065192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 06/30/2024] Open
Abstract
OBJECTIVES Urinary tract infections (UTIs) are common, but overdiagnosed, in children with spina bifida. We sought to evaluate the diagnostic test characteristics of urinalysis (UA) findings for symptomatic UTI in children with spina bifida. METHODS Retrospective cross-sectional study using data from 2 centers from January 1, 2016, to December 31, 2021. Children with myelomeningocele aged <19 years who had paired UA (and microscopy, when available) and urine culture were included. The primary outcome was symptomatic UTI. We used generalized estimating equations to control for multiple encounters per child and calculated area under the receiver operating characteristics curve, sensitivity, and specificity for positive nitrites, pyuria (≥10 white blood cells/high-powered field), and leukocyte esterase (more than trace) for a symptomatic UTI. RESULTS We included 974 encounters from 319 unique children, of which 120 (12.3%) met our criteria for UTI. Pyuria had the highest sensitivity while nitrites were the most specific. Comparatively, nitrites were the least sensitive and pyuria was the least specific. When the cohort was limited to children with symptoms of a UTI, pyuria remained the most sensitive parameter, whereas nitrites remained the least sensitive. Nitrites continued to be the most specific, whereas pyuria was the least specific. Among all encounters, the overall area under the receiver operating characteristics curve for all components of the UA was lower in children who use clean intermittent catheterizations compared with all others. CONCLUSIONS Individual UA findings have moderate sensitivity (leukocyte esterase or pyuria) or specificity (nitrites) but overall poor diagnostic accuracy for symptomatic UTIs in children with spina bifida.
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Affiliation(s)
| | - Rachel G. Miller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Asumi Gibeau
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Theresa Meyer
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Sophia Kamanzi
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nader Shaikh
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David I. Chu
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
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The impact of constant antibiotic prophylaxis in children affected by spinal dysraphism performing clean intermittent catheterization: a 2-year monocentric retrospective analysis. Childs Nerv Syst 2022; 38:605-610. [PMID: 34523011 PMCID: PMC8917099 DOI: 10.1007/s00381-021-05337-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/14/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Spinal dysraphism (SD) is a general term used to refer to developmental abnormalities of the spine that involves many clinical conditions including myelomeningocele (MMC). In these patients, neurogenic bladder (NB) is a common and predisposing factor for renal damage; the most frequently used approach to manage this situation is based on clean intermittent catheterization (CIC) and anticholinergic drugs. Urinary tract infections (UTIs) are a significant concern for these patients, and antibiotic prophylaxis is frequently used even if it is still a debated topic of literature. The purpose of this paper is to investigate the role and the real effectiveness of antibiotic prophylaxis in the reduction of incidence of UTIs in patients with spina bifida performing CIC. METHODS We collected data of all patients performing CIC, who did their last follow-up visit in the period between January 2019 and January 2021, followed at the children multidisciplinary Spina Bifida Center of A. Gemelli Hospital in Rome. Data collected included age at referral, gender, type of SD lesion, serum creatinine and cystatin C levels, the use of anticholinergic medications, antibiotic prophylaxis and type of prophylaxis (oral/endovesical), age of starting prophylaxis with its duration/adherence, number of CIC/day and its duration, episodes of UTIs in the 2 years prior to the last follow-up, and presence and grade of vesical-ureteric reflux (VUR) on cystourethrogram. RESULTS A total of 121 patients with SD performing CIC was included in the study; 66 (54%) presented ≥ 1 episode of UTIs in the last two years and 55 (46%) none. During the study period, 85 (70%) patients received antibiotic prophylaxis (ABP group) and 36 (30%) did not (NABP group): no statistically significative difference in terms of UTI development was observed between the two groups (p = 0.17). We also evaluated compliance to the therapy; 71 patients (59%) took antibiotic prophylaxis constantly (CABP group) and 50 (41%) did not do antibiotic prophylaxis constantly or did not do antibiotic prophylaxis at all (NCABP group): we observed a statistically significative difference in terms of UTIs with a 2.2 times higher risk of development at least one episode of UTIs in NCABP group. CONCLUSION In conclusion, antibiotic prophylaxis performed constantly, without interruption, is associated with a lower risk of developing urinary tract infections and consequently to develop renal failure in adulthood.
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Kane G, Doyle M, Kelly G, Subramaniam R, Cascio S. A multinational survey on the management of the urinary tract in newborns with spina bifida: Are we following current EAU/ESPU guidelines? Neurourol Urodyn 2021; 41:264-274. [PMID: 34609014 DOI: 10.1002/nau.24810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 11/11/2022]
Abstract
AIMS In August 2019, the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) published updated guidelines on the management of neurogenic bladder in children and adolescents. Our study aimed to establish whether members of the ESPU are adhering to these guidelines. METHODS We designed a survey comprising 26 questions using SurveyMonkey®. Respondents were asked about management of neurogenic bladder at birth in newborns with spina bifida (SB), urological investigations, as well as short and long-term follow-up in their institutions. RESULTS There were 103 respondents to the survey (754 recipients, giving a response rate of 14%) spanning 36 countries. 100% of respondents carry out a renal/bladder ultrasound at birth. Only 53% routinely commence clean intermittent catheterization soon after birth as recommended by the guidelines. Only 56% recommend anticholinergic medications after abnormal videourodynamics (VUDs). The guidelines recommend the use of continued antibiotic prophylaxis if there is evidence of vesicoureteral reflux and hostile bladder/non-conclusive results on VUDs which is followed by only 30% of providers. 63% of respondents carry out baseline VUDs at the recommended time. Seeing larger volumes of SB patients, having a formal SB protocol, having formal SB multidisciplinary clinics and working in a tertiary referral center did not make respondents more likely to adhere to guidelines. CONCLUSIONS Our survey demonstrated that large variations from the EAU/ESPU guidelines exist in practice. The study confirms that further work is required across institutions and countries to implement these evidence-based recommendations for standardized practice.
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Affiliation(s)
- Gavin Kane
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Miriam Doyle
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Gabrielle Kelly
- School of Mathematics and Statistics, University College Dublin, Dublin, Ireland
| | - Ramnath Subramaniam
- Department of Paediatric Urology, St. James's University Hospital, Leeds, UK
| | - Salvatore Cascio
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland.,University College Dublin School of Medicine, Dublin, Ireland
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Ben-David R, Carroll F, Kornitzer E, Dekalo S, Mano R, Ben-Chaim J, Cleper R, Bar-Yosef Y. Asymptomatic bacteriuria and antibiotic resistance profile in children with neurogenic bladder who require clean intermittent catheterization. Spinal Cord 2021; 60:256-260. [PMID: 34446838 DOI: 10.1038/s41393-021-00679-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVES To document the prevalence of asymptomatic bacteriuria and to characterize the resistance patterns to antibiotics among children with neurogenic bladder who require clean intermittent catheterization, with an emphasis on multidrug resistance. SETTING A national referral pediatric and adolescent rehabilitation facility in Jerusalem, Israel. METHODS Routine urine cultures were collected before urodynamic studies in suitable individuals during 2010-2018. None of them had symptoms of urinary tract infection at the time of specimen collection. Cultures were defined as being positive if a single bacterial species was isolated together with a growth of over 105 colony-forming units/ml. Resistance patterns were defined as extended-spectrum beta-lactamase (ESBL) and resistant to 3 antimicrobial groups (multi-drug resistant, MDR). RESULTS In total, 281 urine cultures were available for 186 participants (median age 7 years, range 0.5-18). Etiologies for CIC included myelomeningocele (n = 137, 74%), spinal cord injury (n = 16, 9%) and caudal regression syndrome (n = 9, 5%). Vesicoureteral reflux was diagnosed in 36 participants (19%), 14 of whom were treated with prophylactic antibiotics. Asymptomatic bacteriuria was present in 217 specimens (77%, 95%CI [0.72-0.82]). The bacteria species were E. coli (71%), Klebsiella (13%), and Proteus (10%). ESBL was found in 11% of the positive cultures and MDR in 9%, yielding a total of 34 (16% of positive cultures) positive for ESBL and/or MDR bacteria. CONCLUSIONS Asymptomatic bacteriuria and resistance to antimicrobials are common in pediatric individuals who require CIC.
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Affiliation(s)
- Reuben Ben-David
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Fred Carroll
- ALYN Rehabilitation Hospital for Children and Adolescents, Jerusalem, Israel
| | - Emmanuel Kornitzer
- ALYN Rehabilitation Hospital for Children and Adolescents, Jerusalem, Israel
| | - Snir Dekalo
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Mano
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Ben-Chaim
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roxana Cleper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Nephrology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yuval Bar-Yosef
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,ALYN Rehabilitation Hospital for Children and Adolescents, Jerusalem, Israel. .,Pediatric Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Pediatric Urodynamic Study Without a Preprocedural Urine Culture, Is It Safe in Clinical Practice? Urology 2020; 145:224-228. [DOI: 10.1016/j.urology.2020.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022]
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Stein R, Bogaert G, Dogan HS, Hoen L, Kocvara R, Nijman RJM, Quadackers JSLT, Rawashdeh YF, Silay MS, Tekgul S, Radmayr C. EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment. Neurourol Urodyn 2019; 39:45-57. [PMID: 31724222 DOI: 10.1002/nau.24211] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/22/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND In childhood, the most common reason for a neurogenic bladder is related to spinal dysraphism, mostly myelodysplasia. AIMS Herein, we present the EAU/ESPU guidelines in respect to the diagnostics, timetable for investigations and conservative management including clean intermittent catheterization (CIC). MATERIAL AND METHODS After a systematic literature review covering the period 2000 to 2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS The EAU/ESPU guideline panel advocates a proactive approach. In newborns with spina bifida, CIC should be started as soon as possible after birth. In those with intrauterine closure of the defect, urodynamic studies are recommended be performed before the patient leaves the hospital. In those with closure after birth urodynamics should be done within the next 3 months. Anticholinergic medication (oxybutynin is the only well-investigated drug in this age group-dosage 0.2-0.4 mg/kg weight per day) should be applied, if the urodynamic study confirmed detrusor overactivity. Close follow-up including ultrasound, bladder diary, urinalysis, and urodynamics are necessary within the first 6 years and after that the time intervals can be prolonged, depending on the individual risk and clinical course. In all other children with the suspicion of a neurogenic bladder due to various reasons as tethered cord, inflammation, tumors, trauma, or other reasons as well as those with anorectal malformations, urodynamics-preferable video-urodynamics, should be carried out as soon as there is a suspicion of a neurogenic bladder and conservative treatment should be started soon after confirmation of the diagnosis of neurogenic bladder. With conservative treatment the upper urinary tract is preserved in up to 90%, urinary tract infections are common, but not severe, complications of CIC are quite rare and continence can be achieved at adolescence in up to 80% without further treatment. DISCUSSION AND CONCLUSIONS The transition into adulthood is a complicated time for both patients, their caregivers and doctors, as the patient wants to become independent from caregivers and treatment compliance is reduced. Also, transition to adult clinics for patients with neurogenic bladders is often not well-established.
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Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
| | - Hasan S Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Lisette Hoen
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Radim Kocvara
- Department of Urology, 1st Faculty of Medicine in Praha, General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | - Josine S L T Quadackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | | | - Mesrur S Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
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Abstract
OBJECTIVE The utility of the urinalysis as a potential marker to diagnose urinary tract infection (UTI) in patients with neurogenic bladder is controversial. We assessed the baseline urine characteristics and intraindividual variance of pyuria in a cohort of asymptomatic children with neurogenic bladder followed longitudinally. STUDY DESIGN A cohort of 54 children with neurogenic bladder was followed from 2004 to 2015 at a single institution's multidisciplinary clinic. Urine data obtained from 529 routine urology visits were reviewed. Urine obtained within 2 weeks before or after treatment for UTI were excluded. Bladder surgery was defined as any operation that altered the bladder as a closed or sterile system. The effects of age, gender, catheterization, and bladder surgery on pyuria were evaluated using mixed-model regression analysis. RESULTS Fifty patients with 305 urine samples had a mean length of follow-up of 3.2 years. Only 16/50 patients (32%) never had pyuria, and these patients had shorter follow-up compared with the group who ever had pyuria (≥5 white blood cells per high powered field) (1.7 vs. 3.8 years; P = 0.008). Catheterization was associated with a 15% increase in pyuria (P = 0.21). Surgery was associated with a 120% increase in pyuria (P < 0.001). The test-to-test variance of pyuria within an individual was consistently greater than between individuals (P < 0.001). CONCLUSIONS Bladder surgery is associated with significant increases in pyuria among children with neurogenic bladder. The substantial test-to-test variation in pyuria in asymptomatic individuals indicates the low reliability of pyuria, when positive, as a marker for UTI in neurogenic bladder and the need to search for either methods to reduce this variability or alternative biomarkers of UTI in this population.
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Intermittent Catheterization and Urinary Tract Infection: A Comparative Study Between Germany and Brazil. J Wound Ostomy Continence Nurs 2019; 45:521-526. [PMID: 30260906 DOI: 10.1097/won.0000000000000476] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe and compare factors that affect urinary tract infection (UTI) rates in people with spina bifida (SB) and neurogenic bladder dysfunction before and following initiation of intermittent catheterization (IC). DESIGN A quantitative, descriptive, correlational study. SUBJECTS AND SETTING The study included people who were from Germany, a high-income nation, and Brazil, a middle-income nation. Brazilian participants were recruited from a public rehabilitation hospital in the state of Minas Gerais. German participants were drawn from different regions of the country. The study sample included 200 participants; participants were either individuals diagnosed with SB and neurogenic bladder dysfunction and using IC, or caregivers of persons using IC for bladder management. METHODS Data were collected through a survey questionnaire developed for urological follow-up of SB patients. A translated and validated version of the form was used to collect data in Germany. To evaluate annual episodes of UTI, we considered the number of symptomatic UTI before and after IC. RESULTS Participants from Brazil were significantly younger than German patients (median age 9 vs 20 years, P < .001). Brazilians predominately used assisted catheterization (63.0%), whereas most Germans performed self-catheterization (61.0%). Use of IC greatly reduced the incidence of UTI in both groups (mean 2.8 episodes per year before IC vs mean 1.1 episodes after starting IC, P < .001). Women had a higher number of UTI, both before and after IC, but enjoyed greater reduction in UTI after initiating IC than men. Self-catheterization also promoted a greater reduction of UTI than assisted IC (P = .022). CONCLUSIONS Intermittent catheterization reduced annual episodes of UTI in both samples despite differences in catheterization technique. Patients practicing and performing self-catheterization achieved a greater reduction than those who relied on assisted IC. Comparative studies among additional countries with varying median income levels are needed to better understand the needs of individuals with SB and their families, and to plan and implement safe nursing interventions.
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Forster CS, Jackson E, Goldstein SL. Variation among subspecialists in the diagnosis of urinary tract infection in children with neurogenic bladders. J Pediatr Urol 2018; 14:567.e1-567.e6. [PMID: 30177384 DOI: 10.1016/j.jpurol.2018.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/21/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children with neurogenic bladders who require clean intermittent catheterization (CIC) frequently have bacteriuria. However, there is no consensus on what constitutes at urinary tract infection (UTI) in this population. Multiple subspecialists are often involved in the management of these patients, although they are frequently cared for by hospitalists when admission is required. OBJECTIVE The objective of this study was to describe the variability in opinion between subspecialists in the diagnosis of a UTI in CIC-dependent children. STUDY DESIGN A scenario-based survey was distributed to physicians in the divisions of urology, nephrology, and hospital medicine at a single free-standing children's hospital. Respondents rated their degree of confidence on whether a specific scenario represented UTI or colonization on an 11-point Likert Scale. Median responses were compared with the Kruskal-Wallis test with pair-wise comparisons. RESULTS Back/flank pain, abdominal pain, and vomiting were the most common symptoms that were suggestive of a UTI in a non-febrile child. There was no single symptom chosen that was the most suggestive of a UTI in CIC-dependent child. There was significant variability between specialists in the diagnosis of UTI in specific clinical scenarios on the survey. Hospitalists were significantly less confident about the diagnosis of a UTI than urologists in two of the clinical scenarios. CONCLUSIONS Standardization and implementation of consensus criteria for UTI in this high-risk population is needed.
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Affiliation(s)
- C S Forster
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
| | - E Jackson
- Department of Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
| | - S L Goldstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
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Tradewell M, Pariser JJ, Nimeh T, Elliott SP. Systematic review and practice policy statements on urinary tract infection prevention in adults with spina bifida. Transl Androl Urol 2018; 7:S205-S219. [PMID: 29928619 PMCID: PMC5989108 DOI: 10.21037/tau.2018.04.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/03/2022] Open
Abstract
Urinary tract infection (UTI) is a source of morbidity and healthcare costs in adults with spina bifida (ASB). UTI prevention strategies are often recommended, but the evidence of various approaches remains unclear. We performed a systematic review to inform a best practice policy statement for UTI prevention in ASB. On behalf of the Neurogenic Bladder Research Group (NBRG.org), we developed an a priori protocol and searched the published English literature for 30 outcomes questions addressing UTI prevention in ASB. The questions spanned the categories of antibiotics, oral supplements, bladder management factors and social support. Where there was little literature in ASB, we included literature from similar populations with neurogenic bladder (NB). Data was abstracted and then reviewed with recommendations made by consensus of all authors. Level of Evidence (LoE) and Grade of Recommendation (GoR) were according to the Oxford grading system. Of 6,433 articles identified by our search, we included 99 publications. There was sufficient evidence to support use of the following: saline bladder irrigation (LoE 1, GoR B), gentamicin bladder instillation (LoE 3, GoR C), single-use intermittent catheterization (IC) (LoE 2, GoR B), hydrophilic catheters for IC (LoE 2, GoR C), intradetrusor onabotulinumtoxinA injection (LoE 3, GoR C), hyaluronic acid (HA) instillation (LoE 1, GoR B), and care coordination (LoE 3, GoR C). There was sufficient evidence to recommend against use of the following: sterile IC (LoE 1, GoR B), oral antibiotic prophylaxis (LoE 2, GoR B), treatment of asymptomatic bacteriuria (LoE 2, GoR B), cranberry (LoE 2, GoR B), methenamine salts (LoE 1, GoR B), and ascorbic acid (LoE1, GoR B). There was insufficient evidence to make a recommendation for other outcomes. Overall, there are few studies in UTI prevention in the specific population of ASB. Research in populations similar to ASB helps to guide recommendations for UTI prevention in the challenging patient group of ASB. Future studies in UTI prevention specific to ASB are needed and should focus on areas shown to be of benefit in similar populations.
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Affiliation(s)
- Michael Tradewell
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Joseph J Pariser
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Tony Nimeh
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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Zegers SHJ, Dieleman J, van der Bruggen T, Kimpen J, de Jong-de Vos van Steenwijk C. The influence of antibiotic prophylaxis on bacterial resistance in urinary tract infections in children with spina bifida. BMC Infect Dis 2017; 17:63. [PMID: 28081719 PMCID: PMC5228098 DOI: 10.1186/s12879-016-2166-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Bacterial resistance to antibiotics is an increasingly threatening consequence of antimicrobial exposure for many decades now. In urinary tract infections (UTIs), antibiotic prophylaxis (AP) increases bacterial resistance. We studied the resistance patterns of positive urinary cultures in spina bifida children on clean intermittent catheterization, both continuing and stopping AP. Methods In a cohort of 176 spina bifida patients, 88 continued and 88 stopped using AP. During 18 months, a fortnightly catheterized urine sample for bacterial pathogens was cultured. UTIs and significant bacteriuria (SBU) were defined as a positive culture with a single species of bacteria, respectively with and without clinical symptoms and leukocyturia. We compared the percentage of resistance to commonly used antibiotics in the isolated bacteria in both groups. Results In a total of 4917 cultures, 713 (14.5%) had a positive monoculture, 54.3% of which were Escherichia coli. In the group stopping AP, the resistance percentage to antibiotics in UTI / SBU bacteria was lower than in the group remaining on AP, even when excluding the administered prophylaxis. Conclusion Stopping antibiotic prophylaxis for urinary tract infections is associated with reduced bacterial resistance to antibiotics in children with spina bifida. Trial registration ISRCTN ISRCTN56278131. Registered 20 December 2005.
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Affiliation(s)
| | - Jeanne Dieleman
- Máxima Medical Center, Post box 7777, 5500 MB, Veldhoven, The Netherlands
| | | | - Jan Kimpen
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
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12
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Lucas EJ, Baxter C, Singh C, Mohamed AZ, Li B, Zhang J, Jayanthi VR, Koff SA, VanderBrink B, Justice SS. Comparison of the microbiological milieu of patients randomized to either hydrophilic or conventional PVC catheters for clean intermittent catheterization. J Pediatr Urol 2016; 12:172.e1-8. [PMID: 26951923 DOI: 10.1016/j.jpurol.2015.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Control of bacteriuria is problematic in patients who perform clean intermittent catheterization for management of neurogenic bladder. This population is often burdened with multiple urinary tract infections (UTIs), placing them at increased risk of end-stage renal disease. Hydrophilic catheters are a potential way to improve smooth and clean insertion, reduce disruption of the urothelium, and reduce bacterial colonization. OBJECTIVE The goal of the study was to compare the type and virulence of microorganisms recovered from the urine of patients that use either a hydrophilic or conventional polyvinyl chloride (PVC) catheter. METHODS Fifty patients with an underlying diagnosis of myelomeningocele were recruited for a 12-month prospective, randomized, investigator-blinded study. Twenty-five patients were allocated to the hydrophilic catheter intervention, and 25 continued use of a PVC catheter. Cultures were performed on urine obtained by catheterization at enrollment, and 3, 6, and 12 months. Bacterial species were assigned a designation as either potentially pathogenic or non-pathogenic. Escherichia coli isolates were the most predominant and were serotyped to further stratify the pathogenicity of the strains. Lastly, patients were surveyed at enrollment, and at the two later time points evaluating their current catheter for satisfaction. RESULTS A total of 232 different bacterial isolates were obtained from the 182 collected urine cultures. In addition, seven species were recovered from the two UTI reported during the study period. Bacterial growth was not detected in 29 of the samples (16%). Although not statistically significant, collectively there was a 40% decrease in the average number of potentially pathogenic species recovered from those patients using hydrophilic catheters (0.81 per urine sample) compared with PVC catheter use (1.24 per urine sample). Since E. coli species can be either pathogenic or non-pathogenic, we examined 14 of the most commonly implicated serotypes associated with uropathogenic E. coli (UPEC). We identified the serotype of 57% of E. coli strains recovered. There was a trend for the recovery of fewer UPEC serotypes from the hydrophilic group (54% hydrophilic verses 64% PVC), further suggesting that the catheter type may influence the microbiological milieu. Although no significant differences were reported in patient satisfaction, almost half of the patients from the hydrophilic catheter cohort continue use of this type of catheter. CONCLUSIONS There was a trend for reduced recovery of potentially pathogenic bacteria with the use of hydrophilic catheters. The reduction in potentially pathogenic species will reduce antibiotic exposures and some patients may prefer the comfort hydrophilic catheters provide.
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Affiliation(s)
- Elizabeth J Lucas
- Division of Complex HealthCare, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Cheryl Baxter
- Section of Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Chandra Singh
- Section of Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ahmad Z Mohamed
- Department of Urology, University of Louisville, Louisville, KY, USA
| | - Birong Li
- Center for Microbial Pathogenesis at The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jingwen Zhang
- Center for Microbial Pathogenesis at The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, OH, USA
| | - Venkata R Jayanthi
- Section of Urology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Urology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Stephen A Koff
- Section of Urology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Urology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Brian VanderBrink
- Section of Urology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Urology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Sheryl S Justice
- Center for Microbial Pathogenesis at The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, OH, USA; Department of Urology, College of Medicine, The Ohio State University, Columbus, OH, USA
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13
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Kanaheswari Y, Kavitha R, Rizal AMM. Urinary tract infection and bacteriuria in children performing clean intermittent catheterization with reused catheters. Spinal Cord 2014; 53:209-212. [DOI: 10.1038/sc.2014.210] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 10/13/2014] [Accepted: 10/26/2014] [Indexed: 11/09/2022]
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Yıldız ZA, Candan C, Arga M, Turhan P, İşgüven P, Ergüven M. Urinary tract infections in children with myelodysplasia in whom clean intermittent catheterization was administered. Turk Arch Pediatr 2014; 49:36-41. [PMID: 26078630 DOI: 10.5152/tpa.2014.872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/22/2013] [Indexed: 11/22/2022]
Abstract
AIM In this study, it was aimed to evaluate the frequency of significant bacteriuria and antibiotic resistance characteristics in children with myelodysplasia in whom clean intermittent catheterization was administered. MATERIAL AND METHODS The study group was composed of 71 patients with myelodysplasia who were found to have significant bacteriuria (age: 8.20±4.57 years; 39 girls) and the control groups was composed of 49 children who were diagnosed with community-acquired urinary tract infection (age: 7.94±4.17 years; 29 girls). The patient and control groups were evaluated in terms of the microorganisms grown in urinary cultures and antibiotic resistance characteristics. The study approved by the ethics committe (14/02/2012-19/E). RESULTS Growth of Escherichia coli (E. coli) was found with the highest rate in myelodysplasic patients. However, when compared with the control group in terms of microorganism types, an increase in the growth rates of the microorganisms excluding E. coli was observed in the patients with myelodysplasia which was close to the significance limit (p=0.055). When antibiotic resistance properties were examined, a significantly increased resistance against cotrimaxazole was found in the patient group compared to the control group (p=0.001). 84.5% of the patients were using prophylactic antibiotic including mainly co-trimoxazole. A significantly increased co-trimoxazole resistance was also found in the patients who were using prophylactic antibiotic compared to the patients who were not using prophylactic antibiotic (p=0.025). The rate of symptomatic UTI was found to be 21% in the patients with myelodysplasia and a significant increase was found in the complaints of abdominal/side pain and nausea/vomiting as well as fever in these patients compared to the patients with asymptomatic bacteriuria (p=0.029 and p=0.032, respectively). CONCLUSION Our results show that UTI is still a significant problem in patients with myelodysplasia. In addition, they show that use of prophylactic antibiotic may increase the frequency of development of resistance and co-trimoxazole used for this objective is not a good option..
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Affiliation(s)
- Zuhal Albayrak Yıldız
- Department of Pediatrics, The Ministry of Health, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Cengiz Candan
- Unit of Pediatric Nephrology, The Ministry of Health, İstanbul Medeniyet University öztepe Education and Research Hospital, İstanbul, Turkey
| | - Mustafa Arga
- Department of Pediatrics, The Ministry of Health, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Pınar Turhan
- Unit of Pediatric Nephrology, The Ministry of Health, İstanbul Medeniyet University öztepe Education and Research Hospital, İstanbul, Turkey
| | - Pınar İşgüven
- Department of Pediatrics, The Ministry of Health, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Müferet Ergüven
- Department of Pediatrics, The Ministry of Health, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
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Madden-Fuentes RJ, McNamara ER, Lloyd JC, Wiener JS, Routh JC, Seed PC, Ross SS. Variation in definitions of urinary tract infections in spina bifida patients: a systematic review. Pediatrics 2013; 132:132-9. [PMID: 23796735 DOI: 10.1542/peds.2013-0557] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Urinary tract infections (UTIs) are a common source of morbidity among children with spina bifida (SB) and are a frequently reported outcome in studies of this patient population. However, the criteria for a diagnosis of UTI are often not stated. We evaluated the literature on SB patients for the criteria that authors use to define parameters in reporting UTI outcomes. METHODS Embase and Medline were queried with the medical subject heading terms “spinal dysraphism,” “myelomeningocele,” “infection,”and “urinary tract infection.” A second search with the exploded term“spina bifida” and “urinary tract infection” was performed. Original research studies reporting a UTI outcome in SB patients were included and evaluated by 2 independent reviewers for the presence of a UTI definition and diagnostic criteria. RESULTS We identified 872 publications, of which 124 met inclusion criteria. Forty-five of 124 (36.3%) studies reporting UTI as an outcome provided a definition of UTI. Of 124 studies, 28 (22.6%) were published in pediatric journals and 69 (55.6%) in urology journals. A definition of UTI was provided in 11 (39.3%) and 26 (37.7%) studies, respectively. “Fever,culture, and symptoms” defined a UTI in 17 of 45 studies. Journal category and presence of UTI definitions did not correlate (P = .71). CONCLUSIONS Explicit definitions for UTI are heterogeneous and infrequently applied in studies of SB patients, limiting study reliability and estimates of true UTI rates in this population. Future studies will benefit from the development and application of a standard definition for UTI in this population.
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Huynh D, Morgan JA. Use of intravesicular amikacin irrigations for the treatment and prophylaxis of urinary tract infections in a patient with spina bifida and neurogenic bladder: a case report. J Pediatr Pharmacol Ther 2012; 16:102-7. [PMID: 22477833 DOI: 10.5863/1551-6776-16.2.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This case report describes the use of intravesicular amikacin irrigations to treat and prevent urinary tract infections (UTIs) in a pediatric patient with spina bifida and neurogenic bladder. A 15 year old Hispanic female was admitted for a UTI caused by Enterobacter cloacae and multiple-drug resistant Pseudomonas aeruginosa. A 7 day course of daily intravenous amikacin and ceftazidime was initiated along with twice daily intravesicular amikacin irrigations (15 mg/30 mL) with a dwell time of 2 hours. The patient improved and was discharged on prophylactic Bactrim SS (sulfamethoxazole/trimethoprim) 1 tablet daily and intravesicular amikacin irrigations (15 mg/30 mL) once every other day. Approximately 2 months after discharge, the patient developed another UTI from multidrug resistant Escherichia coli and was treated with a 14 day course of daily intravenous ciprofloxacin accompanied by daily intravesicular amikacin irrigations. Adjunctive therapy with either once daily or twice daily intravesicular amikacin irrigations successfully treated the patient's UTI. However, prophylactic treatment with intravesicular amikacin failed to prevent future UTIs in this patient.
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Frimberger D, Cheng E, Kropp BP. The current management of the neurogenic bladder in children with spina bifida. Pediatr Clin North Am 2012; 59:757-67. [PMID: 22857827 DOI: 10.1016/j.pcl.2012.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The urological care of the neurogenic bladder consists of 2 components: medical management with preservation of renal function and quality-oflife issues with achieving dryness and independence of bladder and bowel management. Both components are equally important for patients to live a healthy and fulfilled life. This report explores the diagnosis of the neurogenic bladder; quality-of-life issues that caregivers and patients should expect; the importance of primary care knowledge of the neurogenic bladder and treatment; surgical options; the transition of pediatric patients to adult care; and the importance of caregiver and patient understanding of their disease, treatment options, and responsibilities.
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Affiliation(s)
- Dominic Frimberger
- Section of Pediatric Urology, Robotics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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Wide P, Glad Mattsson G, Mattsson S. Renal preservation in children with neurogenic bladder-sphincter dysfunction followed in a national program. J Pediatr Urol 2012; 8:187-93. [PMID: 21411372 DOI: 10.1016/j.jpurol.2011.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 02/01/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE Neurogenic bladder-sphincter dysfunction (NBSD) constitutes the major reason for morbidity in children with spina bifida. The aim of this study was to identify risk factors for renal damage in children with NBSD followed according to the Swedish national guidelines. MATERIALS AND METHODS Records and cystometries from 6 to 16 years (median 11) follow up of 41 consecutive children born 1993-2003 with NBSD were evaluated. The children were divided into a high pressure group (baseline pressure above 30 cmH(2)O at maximal clean intermittent catheterization volume in at least two cystometries) and a low pressure group. Most children (34/41) were followed from birth. RESULTS Although renal scarring on DMSA-scintigraphy was found in 5/41 children, all but one had normal renal function. Two already had renal scars on entering the follow-up program at age 2.5 and 3 years. Renal scarring was more frequent in the high pressure group (P < 0.01). Most children with renal scars (4/5) had a combination of low compliant bladder and insufficient compliance with treatment and follow up. CONCLUSION High baseline pressure is confirmed as a risk factor that, in combination with complex social issues, creates a demanding situation for families and professionals. A structured early follow up with treatment compliance effectively prevents renal damage.
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Affiliation(s)
- Peter Wide
- Department of Experimental and Clinical Medicine, Division of Paediatrics, Linköping University, SE 581 85 Linköping, Sweden.
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de Kort L, Bower W, Swithinbank L, Marschall-Kehrel D, de Jong T, Bauer S. The management of adolescents with neurogenic urinary tract and bowel dysfunction. Neurourol Urodyn 2012; 31:1170-4. [DOI: 10.1002/nau.22206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 01/10/2012] [Indexed: 11/11/2022]
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Liptak GS, El Samra A. Optimizing health care for children with spina bifida. ACTA ACUST UNITED AC 2010; 16:66-75. [DOI: 10.1002/ddrr.91] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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