BACTERIURIA IN CHILDREN WITH NEUROGENIC BLADDER TREATED WITH INTERMITTENT CATHETERIZATION - NATURAL-HISTORY

Objective: To determine whether bacteriuria unassociated with symptoms in patients with neurogenic bladder will lead to symptomatic infectio n and/or deterioration of the upper urinary tract if left untreated, w e examined whether bacteriuria persisted in bladder urine of children with neurogenic bladder treated with clean intermittent catheterizatio n (CIC) and whether persistence of bacteria led to symptomatic infecti on or deterioration of the upper urinary tract, Design: Weekly home vi sits were made during 6 months of surveillance of 14 children on the C IC regimen with a normal upper urinary tract and no reflux (as determi ned by renal ultrasonography, voiding cystourethrography, and serum cr eatinine measurement). During visits a sample of bladder urine was obt ained by CIC, and signs and symptoms of urinary tract infection and al l medications were recorded. Results: Fourteen children were observed for 323 weeks, Cultures of 70% (172/244) of the urine samples collecte d were positive for organisms (greater than or equal to 10(4) colony-f orming units per milliliter), 152 (88%) for the usual pathogens and 20 (12%) for commensal organisms, Bacteriuria was associated with pyuria two thirds of the time, regardless of bacterial species, Carriage of the same pathogen for 4 weeks or longer, with associated pyuria, was c ommon during surveillance. Despite frequent episodes of bacteriuria wi th associated pyuria, there were only five symptomatic infections duri ng the 323 patient-weeks. Children remained clinically well during the study period, and their upper urinary tract did not deteriorate. Conc lusion: Bacteriuria persists for weeks in symptom-free children being treated with CIC for neurogenic bladder associated with a normal upper urinary tract. Before attempts are made to eradicate bacteriuria, tre atment should be proved to be beneficial to this population.