Uropathogens and Pyuria in Children With Neurogenic Bladders

Area of Science:

• Pediatric Urology
• Infectious Diseases
• Nephrology

Background:

• Specific uropathogens are linked to reduced pyuria in general pediatric populations.
• Children with neurogenic bladders using clean intermittent catheterization (CIC) often present with pyuria.
• Understanding pathogen-pyuria associations in CIC-dependent children is critical.

Purpose of the Study:

• To investigate the association between pyuria and specific uropathogens in children dependent on CIC.
• To determine if certain uropathogens can be present without pyuria in this patient group.

Main Methods:

• Retrospective analysis of urinalysis and urine culture data from 2008-2014.
• Inclusion of pediatric patients (≤18 years) with neurogenic bladders managed with CIC.
• Logistic regression used to assess the relationship between pyuria/leukocyte esterase and specific uropathogens.

Main Results:

• Enterococcus growth was associated with lower odds of pyuria and leukocyte esterase.
• Proteus mirabilis (≥100,000 CFU/mL) correlated with increased odds of pyuria and leukocyte esterase.
• Pseudomonas aeruginosa increased odds of leukocyte esterase but not pyuria.
• Certain neurogenic bladder etiologies (e.g., bladder exstrophy) increased pyuria odds compared to myelomeningocele.

Conclusions:

• Enterococcus can colonize urine in CIC-dependent children without causing pyuria or positive leukocyte esterase.
• Urine cultures are recommended for symptomatic children with neurogenic bladders, regardless of urinalysis findings.
• This highlights the importance of culture-based diagnostics for accurate diagnosis and management.