Urinalysis Abnormalities and Culture Positivity in Children With Clean Intermittent Catheterization

Area of Science:

• Pediatric Nephrology
• Clinical Microbiology
• Diagnostic Accuracy

Background:

• Diagnosing urinary tract infections (UTIs) in children with neurogenic bladder is complex due to frequent bacterial colonization and unreliable symptoms.
• Clean intermittent catheterization (CIC) is common in this population, necessitating effective UTI diagnostic strategies.

Purpose of the Study:

• To evaluate the diagnostic performance of urinalysis parameters in predicting urine culture positivity in children with neurogenic bladder undergoing CIC.
• To identify optimal combinations of urinalysis parameters for predicting UTI in this challenging patient group.

Main Methods:

• Retrospective analysis of 1362 urine samples from 107 pediatric patients with neurogenic bladder undergoing CIC.
• Evaluation of leukocyte esterase (LE), nitrite, pyuria, and bacteriuria, with culture positivity defined as ≥10^5 CFU/mL.
• Statistical analysis including sensitivity, specificity, PPV, NPV, and likelihood ratios for individual and combined parameters using generalized estimating equations.

Main Results:

• The combination of "Nitrite OR Bacteriuria" showed high diagnostic accuracy (AUC 0.84).
• "LE OR Nitrite OR Bacteriuria" demonstrated excellent sensitivity (0.94) and negative predictive value (0.92), suggesting strong rule-out potential.
• "LE AND Nitrite" offered high specificity (0.98) and positive predictive value (0.93) but low sensitivity.

Conclusions:

• Urinalysis parameter combinations can aid in predicting urine culture positivity in children with neurogenic bladder undergoing CIC.
• These findings highlight the utility of specific urinalysis combinations for UTI risk assessment.
• The study acknowledges that these parameters cannot differentiate asymptomatic bacteriuria from clinically significant UTIs requiring treatment.