In:
Pediatric Infectious Disease Journal, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 8 ( 2019-08), p. 804-807
Abstract:
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.
Type of Medium:
Online Resource
ISSN:
0891-3668
DOI:
10.1097/INF.0000000000002370
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
2020216-7
