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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Data availability
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We thank Nurit Twill for administrative assistance.
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RB-D and YB-Y conceived the idea and study design, RB-D analyzed the data, and led manuscript writing; FC, SD, RM, EK assisted with study design, data collection, audited data collection integrity. JB-C, RC, and YB-Y provided consult and guidance in manuscript writing. All authors have reviewed and approved this version of the manuscript.
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The study protocol was reviewed and approved by the Alyns’ hospital Helsinki review committee.
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Ben-David, R., Carroll, F., Kornitzer, E. et al. Asymptomatic bacteriuria and antibiotic resistance profile in children with neurogenic bladder who require clean intermittent catheterization. Spinal Cord 60, 256–260 (2022). https://doi.org/10.1038/s41393-021-00679-5
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DOI: https://doi.org/10.1038/s41393-021-00679-5
