Predictive Factors of Symptomatic UTIs in a Large Cohort of Pediatric Patients Undergoing Voiding Cystourethrogram

To analyze the rate of positive urine cultures at the time of voiding cystourethrogram (VCUG) catheter placement and to identify clinical and demographic risk factors associated with the development of post-VCUG symptomatic infection.

All outpatient VCUG studies with routine urine cultures obtained at the time of catheter placement at a high volume tertiary pediatric care center were retrospectively reviewed from 1/2017 to 12/2022. Demographic data, comorbidities, imaging data, urinalysis (if available), urine culture, and 14-day complications were recorded including lower urinary tract symptoms (LUTS), hospitalization, and fever.

A total of 1705 cases were included with a median age of 4.9. Comorbidities included spina bifida (23.0%), VUR (39.6%), recurrent UTI (46.6%), abnormal ultrasound (40.6%), and the use of prophylactic antibiotics (33.9%). Urine culture was positive in 25% of the cohort, with 4.6% having a symptomatic UTI- LUTS was present in 3.8%, hospitalization secondary to UTI occurred in 0.8%, and 1.6% exhibited post-procedural fever. In those with a positive urine culture, 41.7% were prescribed antibiotics. Age, recurrent UTI and previous ureteral surgery were the only factors associated with symptomatic UTI.

Rates of positive urine culture was 25% at the time of VCUG studies, while the rate of symptomatic UTI was only 4.6%. Of those with positive urine cultures, nearly half received antibiotics. Our findings suggest that only select patients with risk factors would benefit from a urine culture at the time of VCUG, which would avoid over-testing and over-treatment of asymptomatic bacteriuria.