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Published on: June 24, 2025
Urinary tract infection and bacteriuria in children performing clean intermittent catheterization with reused
Y Kanaheswari1, R Kavitha2, A M M Rizal3
1Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Insights
Reusing catheters for clean intermittent catheterization (CIC) for 3 weeks in children with neurogenic bladders increased bacteriuria but did not raise symptomatic urinary tract infection (UTI) rates.
Area of Science:
- Pediatric Urology
- Infectious Diseases
- Nephrology
Background:
- Neurogenic bladder management often involves clean intermittent catheterization (CIC).
- Catheter reuse is common in resource-limited settings, but optimal change frequency requires investigation.
- Understanding the impact of catheter reuse on urinary tract health is crucial for pediatric patient care.
Purpose of the Study:
- To compare the incidence of symptomatic urinary tract infection (UTI) and bacteriuria in children using reused clean intermittent catheterization (CIC) catheters changed weekly versus every three weeks.
- To evaluate the effect of different catheter change frequencies on bacteriuria prevalence and persistence.
Main Methods:
- A comparative cross-sectional, cross-over trial involving 40 children (aged 2-16 years) with neurogenic bladders undergoing CIC for at least 3 years.
- Participants used reused CIC catheters changed every 3 weeks for 9 weeks, followed by weekly changes for another 9 weeks.
- Urine cultures were collected at baseline and every three weeks throughout the 18-week study period.
Main Results:
- Bacteriuria prevalence increased from 65% at baseline to 74% during 3-weekly changes, significantly decreasing to 34% during weekly changes (P<0.001).
- Persistent bacteriuria rates dropped significantly from 60% to 12.5% with weekly catheter changes (P<0.005).
- No symptomatic urinary tract infections (UTIs) were recorded during the study period.
Conclusions:
- Reusing clean intermittent catheterization (CIC) catheters for up to three weeks in children with neurogenic bladders is associated with a higher prevalence of bacteriuria.
- Changing CIC catheters weekly, compared to every three weeks, significantly reduces bacteriuria prevalence and persistence.
- Current evidence suggests that increased bacteriuria from longer catheter reuse intervals does not necessarily lead to symptomatic UTIs in this pediatric population.
Study Design:
This study was designed as a comparative cross-sectional cross-over trial on children performing clean intermittent catheterization (CIC) with reused catheters for 1 or 3 weeks.
Objectives:
To determine the incidence of symptomatic urinary tract infection (UTI) and bacteriuria (defined as colony count of ⩾105 colony forming units per ml of a single strain of organism) in these two different frequencies of catheter change.
Setting:
Multidisciplinary children's neurogenic bladder clinics at two tertiary care hospitals in Kuala Lumpur Malaysia.
Methods:
Forty children aged between 2 and 16 years performing CIC for at last 3 years were recruited. Medical and social data were obtained from case files. Baseline urine cultures were taken. All children changed CIC catheters once in 3 week for the first 9 weeks followed by once a week for the next 9 weeks. Three-weekly urine cultures were obtained throughout the study. Standardization of specimen collection, retrieval and culture was ensured between the two centers.
Results:
At baseline, 65% of children had bacteriuria. This prevalence rose to 74% during the 3-weekly catheter change and dropped to 34% during the weekly catheter change (Z-score 6.218; P<0.001). Persistence of bacteriuria (all three specimens in each 9-week period) changed significantly from 60 to 12.5%, respectively (P<0.005). There was no episode of UTI during the 18-week study period.
Conclusion:
Reuse of CIC catheters for up to 3 weeks in children with neurogenic bladders appears to increase the prevalence of bacteriuria but does not increase the incidence of symptomatic UTI.
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