RELATIONSHIP OF ASYMPTOMATIC BACTERIURIA AND RENAL SCARRING IN CHILDREN WITH NEUROPATHIC BLADDERS WHO ARE PRACTICING CLEAN INTERMITTENT CATHETERIZATION

Objective: To determine whether untreated asymptomatic bacteriurea is associated with renal scarring in children with neuropathic bladders m anaged with clean intermittent catheterization (CIC), Design: Retrospe ctive study of 207 patients aged 1 to 30 years (mean 11.9 +/- 5.5 year s) treated with CIC for a mean duration of 6.6 +/- 3.9 years by the sp ina bifida program at Children's National Medical Center, All patients were examined for renal scarring with dimercaptosuccinic acid (DMSA) renal scans, Catheterized urine cultures were obtained annually, but b acteriuria (> 10,000 colony-forming units of a single organism per mil liliter) was treated only if the patients had symptoms or if vesicoure teral reflux (VUR) was present, Results: Of 207 children, 1 76 (85%) h ad one or more episodes of untreated asymptomatic bacteriuria and 72 ( 35%) had one or more febrile episodes associated with positive urine c ulture results, Biannual DMSA scans detected 54 new scarring episodes in 42 patients, Of newly recognized scars, 55% were preceded within 1 year by a febrile infection, 26% were detected in patients with VUR an d asymptomatic bacteriuria, and 19% were detected in new patients duri ng their initial examination, Univariate analysis revealed that new sc arring was present in 35 of 176 patients with asymptomatic bacteriuria compared with 7 of 31 patients without (P = 809), Logistic regression analysis revealed that factors associated with scarring were febrile infections (adjusted odds ratio [OR] = 30.6, 95% confidence interval ( CI) = 9.8 to 95.8), age more than 20 years (OR = 4.3, CI = 1,01 to 18. 5), the presence of bladder trabeculation (OR = 2.7, CI = 1,0 to 7.6), and VUR (OR = 58.8, CI = 6.3 to 547.3), but asymptomatic bacteriuria was not associated with scarring, Conclusion: In the absence of VUR, a symptomatic bacteriuria in patients undergoing CIC is not a significan t risk factor for scarring and does not require antibiotic therapy.