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Defining Urinary Tract Infections in Children With Spina Bifida: A Systematic Review
Catherine S Forster1,2, Nina N Kowalewski3, Matthew Atienza2
1Children's National Hospital, Washington, District of Columbia forstercs@upmc.edu.
Insights
Researchers found that while more studies now define urinary tract infections (UTI) in children with spina bifida, definitions remain inconsistent. This variability impacts clinical care and research for this high-risk group.
Area of Science:
- Pediatric Urology
- Nephrology
- Clinical Research Methodology
Background:
- Children with spina bifida face a high risk of urinary tract infections (UTI).
- A lack of standardized UTI definitions in this population complicates clinical management and research.
- Previous reviews have highlighted this definitional inconsistency.
Purpose of the Study:
- To assess the frequency of explicit UTI definitions in studies involving pediatric spina bifida patients.
- To identify the parameters commonly used by researchers to define UTI in this cohort.
Main Methods:
- Systematic search of Medline and Scopus databases for relevant pediatric spina bifida studies.
- Inclusion criteria focused on articles using UTI as an outcome.
- Exclusion of articles published before October 2012, non-English articles, and non-primary research.
Main Results:
- Out of 39 included studies, 74% provided an explicit definition for UTI.
- The most frequent UTI definition combined symptoms and culture results (34.5%).
- Definitions varied significantly, with only 3.4% relying solely on urine culture.
Conclusions:
- An increasing number of studies now define UTI in children with spina bifida.
- Despite this improvement, substantial variability in UTI definitions persists.
- This ongoing inconsistency necessitates the development of standardized diagnostic criteria.
Context:
Children with spina bifida are at high risk for urinary tract infections (UTI). However, there is no standardized definition of UTI in this population, leading to variability in both clinical management and research. This was highlighted in the 2013 systematic review on the same topic.
Objective:
Evaluate the frequency with which researchers are defining UTI in their studies of children with spina bifida and to determine what parameters are used.
Data Sources:
We searched Medline and Scopus databases for articles that included pediatric patients with spina bifida and used UTI as an outcome.
Study Selection:
Exclusion criteria included publication before October 1, 2012, non-English language, and nonprimary research articles.
Data Extraction:
Two independent reviewers each extracted data.
Results:
A total of 39 studies were included; 74% of these analyzed included an explicit definition of UTI. The most commonly used definition included a combination of symptoms and culture results (34.5%), whereas 31% used a combination of symptoms, culture results, and urinalysis data. Only 3.4% of articles used a urine culture alone to define UTI.
Conclusions:
More articles that focus on children with spina bifida included a definition of UTI. However, significant variability persists in the definition of UTI in this patient population.
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