Correlation of periurethral bacterial flora with bacteriuria and urinary tract infection in children with neurogenic bladder receiving intermittent catheterization
Ta. Schlager et al., Correlation of periurethral bacterial flora with bacteriuria and urinary tract infection in children with neurogenic bladder receiving intermittent catheterization, CLIN INF D, 28(2), 1999, pp. 346-350
Periurethral bacteria are inoculated daily into the urine of children with
neurogenic bladder during clean intermittent catheterization (CIC). We exam
ined how frequently periurethral bacterial species produced bacteriuria in
children followed longitudinally. When Escherichia coli was detected on the
periurethra, bacteriuria was also present 93% of the time. When Klebsiella
, Pseudomonas, or Enterococcus species or nonpathogens were detected on the
periurethra, bacteriuria was present 80%, 40%, 40%, and 25% of the time, r
espectively. Clonal typing of multiple colonies of E. coli from each periur
ethral and urine culture revealed that children carried only one or two E,
coli clones in their urinary tracts over months of surveillance. When E, co
li was detected in the urine, the identical clone was on the periurethra. E
. coli persisted for weeks in the urine without causing symptoms. Occasiona
lly the same E. coli clone carried for weeks caused a urinary tract infecti
on. Bacteriuria frequently occurs after inoculation of periurethral E. coli
into the urine during CIC.