Bacteriuria in children with neurogenic bladder treated with intermittent catheterization: Natural history

Schlager, Theresa A.; Dilks, Susan A.; Trudell, Julie; Whittam, Thomas S.; Hendley, J. Owen

doi:10.1016/s0022-3476(95)70477-9

Cited by 99 publications

(57 citation statements)

References 21 publications

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“…2,3 At the University of Virginia Pediatric Microbiology Laboratory culture inoculation was performed less than 10 h after collection. Quantitiative culture was done by inoculation of urine onto 5% sheep blood and MacConkey agar with a 0.001 ml calibrated loop.…”

Section: Population and Bacterial Isolatesmentioning

confidence: 99%

“…The children remained clinically well and had no detectable deterioration of the upper urinary tract during 2 years. 3 Escherichia coli was the most common organism causing bacteriuria. Clonal typing of E. coli by multilocus enzyme electrophoresis revealed that children carried only one or two clones in their urinary tracts over months of surveillance.…”

Section: Introductionmentioning

confidence: 99%

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Escherichia coli colonizing the neurogenic bladder are similar to widespread clones causing disease in patients with normal bladder function

et al. 2008

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Study design: Clonal typing of neurogenic clones. Objective: To determine whether neurogenic clones carried over weeks in the urine of asymptomatic children with neurogenic bladder were similar to known uropathogenic clones associated with disease. Setting: Michigan State University; VA Medical Center, Minneapolis, MN, USA. Methods: Escherichia coli isolates from the urine of 15 children previously followed were typed by multilocus sequence typing and compared to 2 human pyelonephritis genome strains, 29 pediatric or adult symptomatic urinary tract infection strains, 15 pediatric asymptomatic bacteriuria strains, 6 animal urinary tract infection strains and a neonatal meningitis-septicemia prototype K1 strain. Phylotypes and virulence genotypes were determined using PCR. Results: Twenty-nine E. coli isolates were classified into 15 clones. Six of 15 clones were the same sequence type or a close relative to a clone that caused disease in a human or animal. These clones were considered uropathogens. The remaining nine clones were not closely related to a clone that caused disease and were considered commensal clones. Uropathogens were predominantly group B2, exhibited more virulence genes and were carried for more weeks in the neurogenic bladder compared to commensal clones. Nine of 15 children carried one or more uropathogenic clones; 4 children carried one or more commensal clones and 2 children carried both uropathogenic and commensal clones. Conclusion: Children with neurogenic bladder most commonly carried commensal clones. Uropathogenic clones were associated with prolonged carriage, however, carriage was not associated with symptomatic disease or deterioration of the upper urinary tract.

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Section: Population and Bacterial Isolatesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Escherichia coli colonizing the neurogenic bladder are similar to widespread clones causing disease in patients with normal bladder function

et al. 2008

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“…A positive urine culture (bacteriuria) was defined as X10 4 colony-forming units of a pathogen per milliliter of urine as previously described. 1 …”

Section: Methodsmentioning

confidence: 99%

“…1 In an effort to decrease the high frequency of bacteriuria in this population we conducted two randomized controlled treatment trials. In separate studies, we examined the effect of daily nitrofurantoin prophylaxis 2 and cranberry prophylaxis 3 on the rates of bacteriuria.…”

Section: Introductionmentioning

confidence: 99%

Effect of a phosphate supplement on urine pH in patients with neurogenic bladder receiving intermittent catheterization

2004

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Objective: To examine a phosphorus supplement as a urine-acidifying agent in patients with neurogenic bladder on clean intermittent catheterization. Methods: Seven patients were followed for 4 weeks. For the first week of study urine pH was measured three times a day: first morning urine sample, afternoon sample, evening sample. For the second and third weeks urine pH was measured and the patients drank a phosphorus supplement three times a day. For the fourth week of study the patients did not take the phosphorus supplement but the measurement of urine pH was continued. The patients were visited in their homes twice a week. During each visit a sample of urine was collected for culture. A supplement container count was performed and urine pH recordings were checked. Results: There was no significant change in urine pH during the 2-week period when a patient was on phosphorus supplementation compared to when the patient was off supplementation. In addition, urine acidification was not achieved over the time period when urine pH was monitored. Conclusion: Phosphate supplementation had no effect on urine pH in patients with neurogenic bladder.

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“…11 As a result, bacteriuria is frequent in urine samples collected from patients who are on IC. 12 In an effort to decrease bacteriuria and subsequent urinary tract infection (UTI) in this population, investigators compared sterile IC with clean IC. 13,14 They found no significant difference in the number of positive urine cultures in the group on IC and sterile technique compared with a second group on IC and clean technique.…”

mentioning

confidence: 99%

Effect of a Single-Use Sterile Catheter for Each Void on the Frequency of Bacteriuria in Children With Neurogenic Bladder on Intermittent Catheterization for Bladder Emptying

2001

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ABSTRACT. Objective. The frequency of bacteriuria is high in children with neurogenic bladder on intermittent catheterization for bladder emptying. In an effort to decrease bacteriuria, we examined whether the method of catheter care was responsible for the high rate of bacteriuria. For this, the frequency of bacteriuria was examined in the same patient on single-use sterile catheters and on reused clean catheters.Methods. A prospective, randomized, crossover trial was conducted with 10 patients who were randomized to 4 months of a new, sterile catheter for intermittent catheterization and 4 months of reuse of a clean catheter for intermittent catheterization. Each week, a urine sample was collected and symptoms of infection and medication use were recorded.Results T he majority of children with neurogenic bladder have loss of control over voiding; urinary retention and bladder distention usually occur in the absence of intervention. Obstruction caused by urinary retention may lead to deterioration of the urinary tract. In addition, urinary retention may result in reflux into the upper urinary tract and subsequent renal damage. 1 Several strategies for complete emptying of the bladder on a regular basis have been tried. [2][3][4][5] Intermittent catheterization (IC) of the bladder several times daily is the preferred method of bladder emptying in patients with neurogenic bladder. 6 -10 A disadvantage of IC is the inoculation of bacteria into bladder urine during the course of repeated catheterization. 11 As a result, bacteriuria is frequent in urine samples collected from patients who are on IC. 12 In an effort to decrease bacteriuria and subsequent urinary tract infection (UTI) in this population, investigators compared sterile IC with clean IC. 13,14 They found no significant difference in the number of positive urine cultures in the group on IC and sterile technique compared with a second group on IC and clean technique.For the next step in an effort to decrease bacteriuria in patients who are on IC, we compared the effect of sterile, single-use catheters with reused, clean catheters in patients who are on IC. Our study was the first prospective, randomized, crossover trial of single, sterile versus reused, clean catheters in outpatients with neurogenic bladder attributable to myelomeningocele. METHODS PatientsPatients who had neurogenic bladder and were on IC 4 times per day were enrolled if they lived at home and had a normal renal ultrasound and no reflux on voiding cystourethrogram. The frequency of bacteriuria in our study group is 75%. 12 All patients continued to receive medical care from their primary physician; no therapies were withheld or altered. The urine cultures obtained for the study did not influence the patient's care, because the results were kept on file by a research technologist and were not available to either the patient's physician or the investigator. The protocol was approved by the University of Virginia Human Investigation Committee.Ten patients enrolled and completed study. Two f...

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Bacteriuria in children with neurogenic bladder treated with intermittent catheterization: Natural history

Cited by 99 publications

References 21 publications

Escherichia coli colonizing the neurogenic bladder are similar to widespread clones causing disease in patients with normal bladder function

Escherichia coli colonizing the neurogenic bladder are similar to widespread clones causing disease in patients with normal bladder function

Effect of a phosphate supplement on urine pH in patients with neurogenic bladder receiving intermittent catheterization

Effect of a Single-Use Sterile Catheter for Each Void on the Frequency of Bacteriuria in Children With Neurogenic Bladder on Intermittent Catheterization for Bladder Emptying

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