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Risk Factors for Recurrent Urinary Tract Infection in Children With Neurogenic Bladder Following Clean Intermittent
Man Jiang1, Jikui Deng2, Guanglun Zhou3
1Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Xicheng District, Beijing, China; Department of Infectious Disease, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China.
Insights
Older age, spinal cord lesions, and bladder issues increase recurrent urinary tract infections (UTIs) in children with neurogenic bladder (NB). These factors also raise the risk of chronic kidney problems.
Area of Science:
- Pediatric Urology
- Nephrology
- Neurology
Background:
- Neurogenic bladder (NB) in children often requires clean intermittent catheterization (CIC).
- Recurrent urinary tract infections (UTIs) are a significant complication in this population.
- Identifying risk factors for recurrent UTIs is crucial for better management and preventing complications.
Purpose of the Study:
- To identify risk factors associated with recurrent UTIs in children managed with CIC for NB.
- To explore the relationship between NB characteristics and recurrent UTI development.
- To assess the long-term outcomes, including chronic renal insufficiency, in children with recurrent UTIs.
Main Methods:
- Retrospective analysis of 327 children (age 9-151 months) with NB managed by CIC over a 5-year period.
- Comparison of demographic, clinical, and urodynamic parameters between children with recurrent UTIs (>1.0 UTI/study-year) and episodic UTIs (≤1.0 UTI/study-year).
- Follow-up duration exceeded 12 months with at least two clinic visits.
Main Results:
- 79 (24.2%) children experienced recurrent UTIs, while 248 (75.8%) had episodic UTIs.
- Significant risk factors for recurrent UTIs included older age, lumbar level spinal cord lesions, long duration of NB, vesicoureteral reflux, increased bladder wall thickness, and low bladder compliance.
- Chronic renal insufficiency was diagnosed more frequently in the recurrent UTI group (39.2%) compared to the episodic UTI group (11.7%).
Conclusions:
- Older age, high-level spinal cord lesions, prolonged NB duration, vesicoureteral reflux, thickened bladder walls, and poor bladder compliance are associated with recurrent UTIs in children with NB.
- Children with NB and recurrent UTIs face an increased susceptibility to developing chronic renal insufficiency.
- These findings underscore the importance of monitoring and managing these risk factors to mitigate UTI recurrence and renal complications.
Objective:
To investigate the risk factors for recurrent urinary tract infection (UTI) in children with a neurogenic bladder (NB) managed by clean intermittent catheterization.
Materials And Methods:
Over a 5-year period, we retrospectively assessed the risk factors for recurrent UTIs in children (age 9-151 months) who had clean intermittent catheterization. All patients were followed up for more than 12 months and had at least two clinic visits during the study period. Demographic, clinical, and urodynamic parameters were assessed. All data were compared between the recurrent UTI (>1.0 UTI/study-year) and episodic UTI (≤1.0 UTI/study-year) groups.
Results:
Of 327 patients, 79 (24.2%) had recurrent UTIs and 248 (75.8%) had episodic UTIs. Univariate and multivariate analyses showed that older age, lumbar level lesions, long duration of NB, presence of vesicoureteral reflux, increased bladder wall thickness, and low bladder compliance were the significant factors for recurrent UTIs. Bladder trabeculation was associated with recurrent UTIs on univariate analysis, but not on multivariate analysis. During the follow-up period, chronic renal insufficiency was diagnosed in 31 (39.2%) and 29 patients (11.7%) in the recurrent and episodic UTI groups (P <.05), respectively.
Conclusion:
These results suggest that older age, high level of spinal cord lesions, long duration of NB, vesicoureteral reflux, increased bladder wall thickness, and low bladder compliance may be directly associated with recurrent UTIs in children with NB. Children with NB might have higher susceptibility to chronic renal insufficiency after recurrent UTIs.
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