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The significance of bacilluria in children on long-term intermittent catheterization
Insights
Clean intermittent catheterization (CIC) in children can lead to bacteriuria (bacteria in urine) in 56% of cases. However, bacteriuria is generally harmless unless high-grade vesicoureteral reflux is present, which can cause pyelonephritis.
Area of Science:
- Pediatric Nephrology
- Urology
- Infectious Diseases
Background:
- Clean intermittent catheterization (CIC) is a common management strategy for pediatric voiding dysfunction.
- The long-term implications of bacteriuria in children undergoing CIC require further elucidation.
Purpose of the Study:
- To determine the incidence of bacteriuria and upper tract changes in children managed with CIC.
- To assess the impact of bacteriuria on renal health in relation to vesicoureteral reflux (VUR).
Main Methods:
- Retrospective review of 255 children managed with CIC over 10 years.
- Analysis of bacteriuria rates, febrile urinary tract infections, and renal damage.
- Correlation of bacteriuria with the presence and grade of VUR.
Main Results:
- Bacteriuria occurred in 56% of children, but febrile urinary tract infections (UTIs) in 11% and renal damage in 2.6%.
- In the absence of VUR, bacteriuria was innocuous, with no development of VUR, hydronephrosis, or scarring.
- Bacteriuria with low-grade VUR was rarely harmful, with reflux resolving in up to 50% of cases.
- Bacteriuria in high-grade VUR was associated with persistent reflux and pyelonephritis in over 60% of patients.
Conclusions:
- Bacteriuria in children undergoing CIC is often benign, particularly without VUR.
- High-grade VUR significantly increases the risk of renal damage and pyelonephritis in the presence of bacteriuria.
- Surgical intervention (reimplantation) should be considered for high-grade VUR with persistent bacteriuria and pyelonephritis.
Abstract:
We reviewed the records of 255 children who have been managed by clean intermittent catheterization during the last 10 years to determine the incidence of bacilluria and upper tract changes. Bacteriuria was documented in 56 per cent of the children but febrile urinary tract infections occurred in only 11 per cent and fresh renal damage in 2.6 per cent. In the absence of vesicoureteral reflux bacilluria proved to be innocuous, since vesicoureteral reflux, progressive hydronephrosis or increasing parenchymal scarring did not develop. Bacteriuria in association with low grade reflux was rarely harmful and the reflux actually disappeared in up to 50 per cent of cases. However, bacteriuria in patients with high grade reflux was not an innocent phenomenon, since not only did the reflux tend to persist but pyelonephritis occurred in more than 60 per cent of the patients. In this latter group of patients reimplantation is an important therapeutic consideration if sterile urine cannot be achieved.