Relationship of asymptomatic bacteriuria and renal scarring in children with neuropathic bladders who are practicing clean intermittent catheterization.
OBJECTIVE
To determine whether untreated asymptomatic bacteriuria is associated with renal scarring in children with neuropathic bladders managed with clean intermittent catheterization (CIC).


METHODS
Retrospective study of 207 patients aged 1 to 30 years (mean 11.9 +/- 5.5 years) treated with CIC for a mean duration of 6.6 +/- 3.9 years by the spina bifida program at Children's National Medical Center. All patients were examined for renal scarring with dimercaptosuccinic acid (DMSA) renal scans. Catheterized urine cultures were obtained annually, but bacteriuria ( > 10,000 colony-forming units of a single organism per milliliter) was treated only if the patients had symptoms or if vesicoureteral reflux (VUR) was present.


RESULTS
Of 207 children, 176 (85%) had one or more episodes of untreated asymptomatic bacteriuria and 72 (35%) had one or more febrile episodes associated with positive urine culture results. Biannual DMSA scans detected 54 new scarring episodes in 42 patients. Of newly recognized scars, 55% were preceded within 1 year by a febrile infection, 26% were detected in patients with VUR and asymptomatic bacteriuria, and 19% were detected in new patients during their initial examination. Univariate analysis revealed that new scarring was present in 35 of 176 patients with asymptomatic bacteriuria compared with 7 of 31 patients without (p = 809). Logistic regression analysis revealed that factors associated with scarring were febrile infections (adjusted odds ratio [OR] = 30.6, 95% confidence interval [CI] = 9.8 to 95.8), age more than 20 years (OR = 4.3, CI = 1.01 to 18.5), the presence of bladder trabeculation (OR = 2.7, CI = 1.0 to 7.6), and VUR (OR = 58.8, CI = 6.3 to 547.3), but asymptomatic bacteriuria was not associated with scarring.


CONCLUSIONS
In the absence of VUR, asymptomatic bacteriuria in patients undergoing CIC is not a significant risk factor for scarring and does not require antibiotic therapy.
Ottolini
M C
MC
Department of General Pediatrics, Children's National Medical Center, Washington, D.C. 20010, USA.
Shaer
C M
CM
Rushton
H G
HG
Majd
M
M
Gonzales
E C
EC
Patel
K M
KM
D000328:Adult; D001437:Bacteriuria / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012307:Risk Factors; D012648:Self Care; D016135:Spinal Dysraphism / Q000150:complications; D004113:Succimer; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D014546:Urinary Catheterization
D015609:Organotechnetium Compounds; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D004113:Succimer