MP55-18 CAN WE RELY ON PYURIA AS A MARKER FOR UTI IN THE NEUROGENIC BLADDER?: AN 11 YEAR LONGITUDINAL ANALYSIS

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2016MP55-18 CAN WE RELY ON PYURIA AS A MARKER FOR UTI IN THE NEUROGENIC BLADDER?: AN 11 YEAR LONGITUDINAL ANALYSIS Ruthie Su, Mari Palta, Amy Lim, Christina Sauder, and Ellen Wald Ruthie SuRuthie Su More articles by this author , Mari PaltaMari Palta More articles by this author , Amy LimAmy Lim More articles by this author , Christina SauderChristina Sauder More articles by this author , and Ellen WaldEllen Wald More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.609AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this era of increasing antibiotic resistance, accurate diagnosis of infection before treatment is imperative. Urinary tract infection (UTI) is a leading cause of morbidity and healthcare utilization for patients with neurogenic bladder and also poses a major diagnostic dilemma. The interpretation of pyuria as a marker for UTI in these patients may be confounded by repeated catheterizations, asymptomatic bacteriuria, or reconstructive surgery. To determine the stability of pyuria in asymptomatic patients with neurogenic bladder we studied the effect of time, catheterization, and bladder surgery on the presence of urinary leukocytes. METHODS All patients evaluated at our institution’s Spina Bifida Clinic since 2004 were eligible. Electronic records were reviewed and only results of microscopic urine analyses obtained the same day as routine, well clinic visits were included. Clean intermittent catheterization (CIC) status at the time of urine collection and bladder surgical history (ie: reimplant, augment, Mitrofanoff, vesicostomy) were recorded. Analysis of repeated measurements was done with SAS, using multi-level modeling with random effects. RESULTS 53 patients (32 female, 21 male) were evaluated during well visits between March 2004 to March 2015. There were on average 10 visits (range 2-41) per person. 319 urine samples were included for analysis. 51% (27/53) of patients transitioned during the study period from spontaneously voiding to CIC. 28% (15/53) of patients underwent some form of bladder surgery. Pyuria increased on average with time, CIC, and bladder surgery but not significantly. Within individual variance was significant (p<0.001) and 6 times greater than between individual variance, accounting for 58%-86% of the total variation as age increased. Adjusting for age, CIC, or bladder surgery did not reduce intra-individual variance. CONCLUSIONS Pyuria varies unpredictably in asymptomatic children with neurogenic bladder. Accordingly, pyuria does not appear to be useful as a point of care marker for UTI, underscoring the importance of the need to search for other inflammatory biomarkers in these complex patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e743 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ruthie Su More articles by this author Mari Palta More articles by this author Amy Lim More articles by this author Christina Sauder More articles by this author Ellen Wald More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...