Variation in Definitions of Urinary Tract Infections in Spina Bifida Patients: A Systematic Review

Abstract

OBJECTIVE: Urinary tract infections (UTIs) are a common source of morbidity among children with spina bifida (SB) and are a frequently reported outcome in studies of this patient population. However, the criteria for a diagnosis of UTI are often not stated. We evaluated the literature on SB patients for the criteria that authors use to define parameters in reporting UTI outcomes. METHODS:Embase and Medline were queried with the medical subject heading terms "spinal dysraphism," "myelomeningocele," "infection," and "urinary tract infection." A second search with the exploded term "spina bifida" and "urinary tract infection" was performed. Original research studies reporting a UTI outcome in SB patients were included and evaluated by 2 independent reviewers for the presence of a UTI definition and diagnostic criteria. RESULTS:We identified 872 publications, of which 124 met inclusion criteria. Forty-five of 124 (36.3%) studies reporting UTI as an outcome provided a definition of UTI. Of 124 studies, 28 (22.6%) were published in pediatric journals and 69 (55.6%) in urology journals. A definition of UTI was provided in 11 (39.3%) and 26 (37.7%) studies, respectively. "Fever, culture, and symptoms" defined a UTI in 17 of 45 studies. Journal category and presence of UTI definitions did not correlate (P = .71).CONCLUSIONS: Explicit definitions for UTI are heterogeneous and infrequently applied in studies of SB patients, limiting study reliability and estimates of true UTI rates in this population. Future studies will benefit from the development and application of a standard definition for UTI in this population. Dr Madden-Fuentes conceptualized and designed the study, collected and analyzed the data, drafted the initial manuscript, and approved the final manuscript for submission. Dr McNamara assisted with study design, data collection, and data analysis; reviewed and revised early manuscript drafts; and approved the final manuscript for submission. Dr Lloyd assisted with designing the systematic review, reviewed and revised early manuscript drafts, and approved the final manuscript for submission. Dr Wiener assisted with study design, reviewed and revised early manuscripts, and approved the final manuscript for submission. Dr Routh assisted with designing the systematic review and data analysis, reviewed and revised early manuscript drafts, and approved the final manuscript for submission. Dr Seed contributed to the conception of this study, reviewed and revised early manuscripts, and approved the final manuscript for submission. Dr Ross conceptualized and designed the study, reviewed and revised early manuscripts, and approved the final manuscript for submission.www.pediatrics.org/cgi

Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders

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