Related Experiment Videos
Screening for urinary tract infection in children with neurogenic bladders
G S Liptak1, J Campbell, R Stewart
1Department of Pediatrics, University of Rochester, School of Medicine and Dentistry, NY 14642-0777.
Insights
A combined dipstick test for nitrite and leukocyte esterase offers a dependable screening method for urinary tract infections (UTIs) in children with neurogenic bladders, reducing the need for frequent bacterial cultures.
Area of Science:
- Pediatric Nephrology
- Urology
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) are a common and serious complication in children with neurogenic bladders, often linked to conditions like meningomyelocele.
- Current monitoring methods involving frequent bacterial cultures are costly and burdensome for patients and healthcare systems.
- There is a need for an economical and reliable screening tool to detect UTIs in this vulnerable pediatric population.
Purpose of the Study:
- To evaluate the effectiveness of a dipstick urinalysis test, specifically for nitrite and leukocyte esterase, as a screening tool for UTIs in children with neurogenic bladders.
- To compare the diagnostic accuracy of the dipstick test with clinical signs and symptoms and the presence of vesicoureteral reflux.
- To determine if a combination of nitrite and leukocyte esterase provides a more sensitive and specific screening method than individual tests.
Main Methods:
- A study involving 141 children with neurogenic bladders, with 329 urine specimens collected over 11 months.
- Comparison of bacterial culture results (≥100,000 CFU/ml) with clinical signs/symptoms, presence of reflux, and dipstick test results for nitrite and leukocyte esterase.
- Calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for different diagnostic approaches.
Main Results:
- UTIs were significantly more prevalent in children with vesicoureteral reflux.
- Clinical signs and symptoms showed low sensitivity and specificity for UTI detection (PPV=0.44, NPV=0.84).
- The dipstick urinalysis test alone was unreliable (PPV=0.63, NPV=0.73), but the combination of nitrite and leukocyte esterase demonstrated improved performance (PPV=0.69, NPV=0.88).
Conclusions:
- Children with neurogenic bladders and reflux or significant symptoms warrant continued regular bacterial cultures.
- The combined nitrite and leukocyte esterase dipstick test serves as a dependable screening tool for UTIs in children with neurogenic bladders who do not fall into the high-risk category.
- This approach can help optimize resource allocation by reducing unnecessary bacterial cultures.
Abstract:
Urinary tract infections (UTIs) are a frequent and potentially disabling problem for children with neurogenic bladders. Frequent monitoring for UTIs using bacterial culture is expensive and troublesome; thus an inexpensive, dependable screening method is desirable. Three hundred and twenty-nine urine specimens were obtained from 141 children with neurogenic bladders, 86% of whom had meningomyelocele. During the 11-month study period, 43% of the children had at least one positive culture (> or = 100,000 CFU/ml). The results of bacterial culture were compared with the occurrence of signs and symptoms, the presence of reflux and the results of a dipstick test for nitrite and leukocyte esterase. Analysis of the data revealed that (1) UTIs were significantly more common in children with reflux; (2) the presence of signs and symptoms was neither sensitive nor specific (positive predictive value (PPV) = 0.44, negative predictive value (NPV) = 0.84); (3) urinalysis was an unreliable screening tool (PPV = 0.63, NPV = 0.73); and (4) the combination of nitrite and leukocyte esterase was more sensitive and specific than either by itself (combined PPV = 0.69, NPV = 0.88). Children with neurogenic bladders who have reflux or have signs and symptoms should continue regular bacterial cultures, whereas others can be screened dependably using the combined leukocyte esterase and nitrite test.