Periurethral colonization and urinary leukocytes as markers for bacteriuria in children with neurogenic bladder

Schlager, Theresa A.; Dilks, Susan A.; Lohr, Jacob A.; Hayden, Gregory F.; Kopco, J. A.; Hendley, Joy

doi:10.1007/bf00922749

Cited by 7 publications

(3 citation statements)

References 11 publications

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“…Further, as it takes approximately 4 hours for bacteria to convert nitrates to nitrites, the amount of time that the urine is in the bladder also impacts the presence of nitrites on urinalysis [21]. Despite this, nitrites have good utility in predicting of bacteriuria in children with neurogenic bladder [22], and therefore are frequently used clinically in this situation. As 29% of patients in the UTC group had positive nitrites, we repeated the ROC curve analysis after excluding these patients as they may represent misclassified UTI patients.…”

Section: Discussionmentioning

confidence: 99%

Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders

Forster

Jackson

et al. 2018

Pediatr Nephrol

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Background Distinguishing between urinary tract infection (UTI) and colonization (UTC) in patients with neurogenic bladders who require clean intermittent catheterization (CIC) is difficult. Urinary neutrophil gelatinase-associated lipocalin concentrations (uNGAL) are increased in UTIs. Our objective was to determine the predictive accuracy of uNGAL for UTI in CIC-dependent children. Methods Cross-sectional study of CIC-dependent patients from August, 2015 to November, 2016. UTI was defined as (1) growth of ≥ 50,000 cfu/mL of a uropathogen, (2) > 10 urinary white blood cells/hpf, and (3) ≥ 2 of the following: temperature > 38 °C, abdominal pain, back pain, worsened incontinence, pain with catheterization, or malodorous/cloudy urine. Positive urine cultures that did not meet these criteria were grouped as UTC, and negative cultures were grouped as no growth. Results Two hundred one patients were included (no growth = 100, UTC = 77, UTI = 24). Median (interquartile range) uNGAL was higher in the UTI group (UTI 1361 (931, 2516) μg/g creatinine, UTC 246 (106, 548) μg/g creatinine, no growth 36 (11, 179) μg/g creatinine, p < 0.01 for all comparisons). The area under the ROC curve for uNGAL for UTI versus no UTI was 0.89, 95% CI (0.80–0.98). Conclusion uNGAL is elevated in CIC-dependent children with UTI compared to those with negative cultures and those with UTC.

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Section: Discussionmentioning

confidence: 99%

Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders

Forster

Jackson

et al. 2018

Pediatr Nephrol

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“…However, as has been described by Schlager et al [4,7], the pyuria did not differentiate asymptomatic bacteriuria from symptomatic infection (86% AB and 97% symptomatic UTI). We observed that the pyuria remained during the period in which the bacteriuria persisted, in some instances for weeks or months, without the development of UTI symptoms.…”

Section: Discussionmentioning

confidence: 59%

“…It has been well established that healthy schoolgirls with asymptomatic bacteriuria (AB) and normal bladder function present a low risk for symptomatic UTI and the development of renal damage. However, it is unknown whether the expression of virulence factors by an E.coli clone colonizing the neurogenic bladder increases the risk of subsequent infection [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

E. coli virulence factors in children with neurogenic bladder associated with bacteriuria

et al. 2005

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The value of E. coli virulence factors in patients with neurogenic bladder has not been established. The aim of this study is to correlate E. coli virulence factors with asymptomatic and symptomatic UTI in children with neurogenic bladder. Fifty E. coli strains, which were collected in sequence, underwent analysis in relation to: the association to pyuria, serotype (O:H), the presence of genes and expression of fimbriae P, type 1, S and hemagglutinin Dr, the presence of the gene and production of hemolysins and cytotoxins (CNF1). We also analyzed the cell adherence capability and pattern and presence of usp (uropathogenic-specific protein). Pyuria was present in most of the positive urine cultures, with 86% AB and 97% UTI. Low rates of uropathogenic strains were observed in the two groups, with 18% AB and 21% UTI. Type 1 fimbria predominated in 44% of the E. coli strains. Of the bacteria studied, 30% (15 strains) exhibited papG genotypes (11 class II and 4 class III). Of these, 12/15 patients presented AB. Production of hemolysins was detected in 38% of the strains (16 AB and 3 UTI) and usp in only 18% of the strains, with 8 AB and 1 UTI. Adherence tests demonstrated the adhesive capacity in all samples analyzed. Neither group (AB or symptomatic UTI) presented a statistically significant difference in relation to the virulence factors studied. E. coli clones that caused symptomatic UTI in children with neurogenic bladder expressed few virulence factors, with no statistically significant difference in comparison to the AB group.

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Symptom- and urinalysis-based approach to diagnosing urinary tract infections in children with neuropathic bladders

Forster

Wang

2020

Pediatr Nephrol

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Periurethral colonization and urinary leukocytes as markers for bacteriuria in children with neurogenic bladder

Cited by 7 publications

References 11 publications

Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders

Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders

E. coli virulence factors in children with neurogenic bladder associated with bacteriuria

Symptom- and urinalysis-based approach to diagnosing urinary tract infections in children with neuropathic bladders

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