Ta. Schlager et al., BACTERIURIA IN CHILDREN WITH NEUROGENIC BLADDER TREATED WITH INTERMITTENT CATHETERIZATION - NATURAL-HISTORY, The Journal of pediatrics, 126(3), 1995, pp. 490-496
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.