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Published on: June 24, 2025
Home screening for bacteriuria in children with spina bifida and clean intermittent catheterization
Bas S H J Zegers1, Cuno C S P M Uiterwaal, Carla C Verpoorten
1Department of Pediatrics, Máxima Medical Center Veldhoven, The Netherlands. b.zegers@mmc.nl
Insights
Leukocyte esterase tests (LETs) can reliably exclude significant bacteriuria (SBU) in children with spina bifida at home. Dip slides offer no diagnostic advantage for SBU in this population.
Area of Science:
- Pediatric Nephrology
- Urology
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) and significant bacteriuria (SBU) are prevalent in spina bifida patients with neuropathic bladder.
- Current gold standard for SBU diagnosis, laboratory culture, causes delays.
- Leukocyte esterase tests (LETs) and dip slides are potential rapid alternatives.
Purpose of the Study:
- To evaluate the diagnostic accuracy of LETs and dip slides for SBU in children with spina bifida.
- To assess the utility of these tests in asymptomatic children, a population not previously studied.
Main Methods:
- A comparative study involving 112 children with spina bifida undergoing clean intermittent catheterization.
- Urine samples were analyzed using LETs, dip slides, and laboratory agar cultures.
- Hypothesis: Home-based tests are as accurate as laboratory cultures.
Main Results:
- Significant bacteriuria (SBU) detected in 40% of patients via culture.
- Negative LET demonstrated a 96% negative predictive value for excluding SBU.
- Positive LET showed a 72% positive predictive value with a 28% false positive rate.
Conclusions:
- Leukocyte esterase testing is a reliable tool for ruling out SBU in spina bifida patients at home.
- Dip slide tests provide no additional diagnostic value for SBU detection or exclusion in this cohort.
Background:
Significant bacteriuria (SBU) and urinary tract infections (UTIs) are common in patients with spina bifida and neuropathic detrusor sphincter dysfunction. Laboratory agar plated culture is the gold standard to establish SBU. It has the disadvantage of diagnostic and subsequent therapeutic delay. Leukocyte esterase tests (LETs) and dip slides proved to be useful in the general populations to exclude SBU and UTI. The aim of this study was to evaluate the reliability of LET and dip slide in children with spina bifida without symptoms of UTI. The reliability in children with asymptomatic SBU was not studied before.
Methods:
In one hundred and twelve children with spina bifida on clean intermittent catheterization LETs and dip slides were compared with laboratory cultures. Both tests and agar plated cultures were performed on catheterized urine samples. The hypothesis was that the home tests are as accurate as laboratory cultures.
Results:
A SBU was found in 45 (40%) of the 112 laboratory cultures. A negative LET excluded SBU (negative predictive value 96%), while a positive LET had a positive predictive value of 72%. The false positive rate was 28%. Dip slide determination of bacterial growth had no added value, other than serving as transport medium.
Conclusions:
In spina bifida children, leukocyte esterase testing can be used to exclude significant bacteriuria at home, while dip slide tests have no added value to diagnose or exclude significant bacteriuria.
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