Predominant bacteria and patterns of antibiotic susceptibility in urinary tract infection in children with spina bifida

Ortiz, Tara K.; Velazquez, Nermarie; Ding, Laura; Routh, Jonathan C.; Wiener, John S.; Seed, Patrick C.; Ross, Scott E.

doi:10.1016/j.jpurol.2018.03.017

Cited by 13 publications

(10 citation statements)

References 25 publications

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“…18,19 One study found that children with MMC have a 10-fold increased risk of urosepsis. 8 Yet, MMC patients are prone to the presence of bacteria in their urine even without developing signs of UTI given their NGB and increased requirement for regular instrumentation of their urinary tract. Schlager et al performed weekly urine cultures for 6 months on 14 children with NGB on CIC and found 70% of cultures grew ≥10,000 CFU.…”

Section: Discussionmentioning

confidence: 99%

“…6 Yet, CIC can introduce bacteria into the bladder and potentially contribute to the risk of UTI. 7,8 While the benefits of different catheterization techniques or types of catheters have long been debated in an effort to reduce infectious inoculation, 9,10 CIC itself remains a potential source for the introduction of bacteria into the urinary system. As a result, patients with NGB on CIC have high rates of bacteria in their urine.…”

mentioning

confidence: 99%

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Implications of Bacteriuria in Myelomeningocele Patients at Time of Urodynamic Testing

Preece

Haynes

Gupta

et al. 2019

Topics in Spinal Cord Injury Rehabilitation

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Objective: To identify those myelomeningocele (MMC) patients at risk for post-urodynamic study (UDS) complications. We hypothesized that patients who manage their bladder with clean intermittent catheterization (CIC) would have a greater risk of post-instrumentation complications due to higher rates of bacteriuria compared to those who freely void (FV). Design/Methods: Urine was collected from patients with MMC without augmentation cystoplasty undergoing routine renal ultrasound or urodynamic study (UDS). Samples were divided into those with bacteriuria (urine culture ≥10,000 colony-forming units) and those without. Post-UDS complications were evaluated and compared between CIC and FV patients. Results: A total of 91 urine samples from 82 total MMC patients were included for evaluation. Significantly more patients on CIC than those who FV had bacteriuria (67% vs 33%, p = .0457). From these urine samples, 54 were obtained at time of UDS of which 45 were from patients on CIC and 9 from FV patients. More patients on CIC had bacteriuria at the time of UDS than those who FV (60% vs 33%, respectively), but this did not reach significance ( p = .1416). No patient with bacteriuria on CIC had a complication after UDS while one FV patient with bacteriuria developed post-UDS pyelonephritis. Conclusion: MMC patients with bacteriuria on CIC did not have post-UDS complications. Patients with bacteriuria who FV may be at particular risk for post-instrumentation UTI, providing guidance as to which MMC patients should undergo urine testing prior to UDS in order to prevent post-instrumentation pyelonephritis.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Implications of Bacteriuria in Myelomeningocele Patients at Time of Urodynamic Testing

Preece

Haynes

Gupta

et al. 2019

Topics in Spinal Cord Injury Rehabilitation

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“…30 A recent study by Ortiz et al found that in children with UTI, those with MMC had double the rate of MDR organisms compared to those without MMC (21% vs 10%; p < .01). 3 While patients with NGB are at increased risk of UTI, they also commonly have ASB, 10 likely contributing to inappropriate antibiotic exposure.…”

Section: Sample Analysismentioning

confidence: 99%

“…1 Patients with NGB are at particularly high risk of developing urinary tract infections (UTI). [2][3][4] It is estimated that patients with MMC will have at least one UTI by 15 months of age. 5 This can result in significant morbidity, with MMC patients more likely to develop urosepsis compared to an age-matched group of non-MMC children with a history of a single symptomatic UTI.…”

mentioning

confidence: 99%

“…5 This can result in significant morbidity, with MMC patients more likely to develop urosepsis compared to an age-matched group of non-MMC children with a history of a single symptomatic UTI. 3 Patients with NGB are predisposed to UTIs due to incomplete bladder emptying and neurogenic bowel dysfunction that also occur as a result of their spinal cord abnormality. 6 In addition, these patients often require frequent instrumentation of their urinary tract and/or have urinary tract reconstructions that may put them at risk for recurrent infections.…”

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confidence: 99%

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Differentiating Asymptomatic Bacteriuria From Urinary Tract Infection in the Pediatric Neurogenic Bladder Population: NGAL As a Promising Biomarker

Gupta

Preece

Haynes

et al. 2019

Topics in Spinal Cord Injury Rehabilitation

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Objective: To evaluate whether urinary antimicrobial peptides (AMPs) can discriminate between asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) in pediatric patients with neurogenic bladder (NGB). Design/Methods: Bladder urine was collected from pediatric patients (≤18 years old) with NGB without augmentation cystoplasty. Patients were divided into the following groups based on symptomatology and results of urinalysis/urine culture: (a) UTI, (b) ASB, and (c) sterile. Urine AMPs β defense 1 (BD-1), neutrophil gelatinase-associated lipocalin (NGAL), cathelicidin (LL-37), hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), and human α defensin 5 (HD-5) were compared between groups by enzyme-linked immunosorbent assays. In addition, urines from pediatric controls without NGB or UTI were also analyzed. Significance was determined using Student's t test for parametric or Mann-Whitney U test for nonparametric data. A p value of <.05 was considered significant. Results: Thirty-six patients with NGB from a spinal dysraphism were evaluated: UTI, n = 6; ASB, n = 18; sterile, n = 12. These groups did not differ significantly by age but did significantly differ by gender ( p = .0139). NGAL significantly differed between UTI and ASB groups (median 38.5 ng/mg vs 15.5 ng/mg, respectively; p = .0197) with a sensitivity and specificity of 82.4% and 83.3%, respectively. HIP/PAP, BD-1, HD-5, LL-37, and NGAL levels were all significantly higher in sterile NGB urines compared to 17 non-NGB pediatric controls ( p < .0001, p = .0020, p = .0035, p = .0006, and p = .0339, respectively). Conclusion: All five urinary AMPs evaluated were significantly elevated in NGB patients compared to controls. NGAL levels may help differentiate between UTI and ASB in pediatric NGB patients.

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Intravenous antibiotics for urinary tract infections in children with neurologic impairment

Starnes,

Hall,

Williams

et al. 2024

Journal of Hospital Medicine

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BackgroundChildren with high‐intensity neurologic impairment (HINI) have an increased risk of urinary tract infection (UTI) and prolonged intravenous (IV) antibiotic exposure.ObjectiveTo determine the association between short (≤3 days) and long (>3 days) IV antibiotic courses and UTI treatment failure in hospitalized children with HINI.MethodsWe performed a retrospective cohort study examining UTI hospitalizations at 49 hospitals in the Pediatric Health Information System from 2016 to 2021 for children (1–18 years) with HINI. The primary outcome was UTI readmission within 30 days. Our secondary outcome was the association of hospital‐level variation in short IV antibiotic course use with readmission. Readmission rates were compared between short and long courses using multivariable regression.ResultsOf 5612 hospitalizations, 3840 (68.4%) had short IV antibiotic courses. In our adjusted model, children with short IV courses were less likely than with long courses to have a 30‐day UTI readmission (4.0%, 95% CI [3.6%, 4.5%] vs. 6.3%, 95% CI [5.1%, 7.8%]). Despite marked hospital‐level variation in short IV course use (50.0%–87.5% of hospitalizations), there was no correlation with readmissions.ConclusionsChildren with HINI hospitalized with UTI had low UTI readmission rates, but those who received long IV antibiotic courses were more likely to experience UTI readmission versus those receiving short courses. While residual confounding may influence our results, we did not find that short IV courses impacted readmission at the hospital level despite variation in use across institutions. Long IV antibiotic courses are associated with risks and may not confer benefit in this population.

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Predominant bacteria and patterns of antibiotic susceptibility in urinary tract infection in children with spina bifida

Cited by 13 publications

References 25 publications

Implications of Bacteriuria in Myelomeningocele Patients at Time of Urodynamic Testing

Implications of Bacteriuria in Myelomeningocele Patients at Time of Urodynamic Testing

Differentiating Asymptomatic Bacteriuria From Urinary Tract Infection in the Pediatric Neurogenic Bladder Population: NGAL As a Promising Biomarker

Intravenous antibiotics for urinary tract infections in children with neurologic impairment

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