Diagnostic evaluation and treatment of UTIs in children with neurogenic bladder.

Objective: Children with neurogenic bladder (NGB) are at increased risk for urinary tract infections (UTIs), but there is a lack of guidelines to assist clinicians in diagnosing and treating these children. Our objective was to describe the presentation and treatment of provider diagnosed UTIs in children with NGB compared to children with vesicoureteral reflux (VUR) and to assess the proportion of children with NGB who met a consortium definition of UTI.

Study design: We included children <18 years old with either VUR or NGB who were diagnosed in the emergency department with a febrile UTI in our multicenter retrospective cohort study. We extracted and compared UTI symptoms and urinalysis results specific to children with NGB to children with VUR. We measured the proportion of UTI diagnoses concordant with the Urologic Management to Preserve Initial Renal Function (UMPIRE) consensus definition of UTI, defined as ≥ 100,000 CFU/mL of 1 or 2 organisms, pyuria, and ≥ two symptoms of UTI.

Results: The most common symptom among all children in the cohort was vomiting (38.8 %). Of the 215 children with NGB, 41.3 % met the UMPIRE definition for UTI. More children with NGB had multidrug resistant organisms (MDROs) cultured from their urine than those with VUR. Children with NGB, both who did and did not require CIC, had increased odds of MDRO in urine culture compared to those with VUR. Children with NGB were more likely to be prescribed broad-spectrum antibiotics than children with VUR.

Conclusions: Most children with NGB diagnosed with febrile UTI in the ED did not meet a commonly recommended definition for UTI. The higher prevalence of MDRO UTIs and broad-spectrum antibiotic use in children with NGB highlights the need for accurate diagnostic approaches for UTI in this population, as well as the difficulty in diagnosing UTI in patients with NGB.