Culture-positive urinary tract infection following micturating cystourethrogram in children
Simeon Ngwesoab*(),Munyaradzi Nyandoroa,Tatenda Nzenzabc,Ting Yi Cheowd,Fiona Bettenaye,Andrew Barkere,Japinder Khosae,Naeem Samnakayef
aFiona Stanley Hospital. Murdoch, Western Australia, Australia bYoung Urology Researchers Organisation, Melbourne, Australia cAustin Hospital, Heidelberg, Victoria, Australia dRoyal Perth Hospital, Perth, Western Australia, Australia ePrincess Margaret Hospital, Subiaco, Western Australia, Australia fSchool of Medicine, University of Western Australia, Dalkeith, Western Australia, Australia
Objective: To determine the incidence of culture-positive urinary tract infection (UTI) after micturating cystourethrogram (MCUG). We further wanted to identify risk factors for developing a culture-positive UTI following MCUG. Methods: A retrospective review of the available medical records of 500 paediatric patients who underwent MCUG in Perth, Western Australia was performed. Results: Seven (1.4%) patients comprised of four females and three males developed a febrile, culture-positive UTI within 14 days following MCUG. Significant association was found for female patients, patients with neurogenic bladder, and patients with previous culture-positive UTI as developing a culture-positive UTI following MCUG. Multivariate logistic regression determined that patients were more likely to develop culture-positive UTI within 14 days following MCUG if they had a known history of UTI (odds ratio: 5.0, 95% confidence interval: 1.5-17.3, p=0.010) or had a neurogenic bladder (odds ratio: 4.2, 95% confidence interval: 1.0-17.9, p=0.049). Conclusion: The incidence of patients who developed a febrile, culture-positive UTI following MCUG was low at 1.4%. Statistically significant and independent associations for the development of culture positive UTI were found in patients with neurogenic bladder and patients with previous culture-positive UTI. Further prospective studies are necessary to determine necessity of prophylactic antibiotics for high-risk patients, e.g., patients with neurogenic bladder or previous culture-positive UTI.
. [J]. Asian Journal of Urology, 2022, 9(3): 329-333.
Simeon Ngweso,Munyaradzi Nyandoro,Tatenda Nzenza,Ting Yi Cheow,Fiona Bettenay,Andrew Barker,Japinder Khosa,Naeem Samnakay. Culture-positive urinary tract infection following micturating cystourethrogram in children. Asian Journal of Urology, 2022, 9(3): 329-333.
Age in months at time of micturatingcystourethrogram
0-6
281 (56.2)
7-12
51 (10.2)
13-24
30 (6.0)
25-48
39 (7.8)
49-60
15 (3.0)
61-144
65 (13.0)
145-228
19 (3.8)
Gender
Male
276 (55.2)
Female
224 (44.8)
Admission status
Inpatient
110 (22.0)
Outpatient
390 (78.0)
Indication for micturatingcystourethrogram
Post urinary tract infection evaluation
235 (47.0)
Antenatal hydronephrosis
160 (32.0)
Upper tract structural anatomical anomalya
68 (13.6)
Neurogenic bladder
43 (8.6)
Bladder dysfunction
36 (7.2)
Assessment of known vesicoureteral reflux
29 (5.8)
Ano-rectal malformation
16 (3.2)
Bladder structural/anatomical anomaly
15 (3.0)
Investigation after epididymitis
4 (0.8)
Known posterior urethral valve
3 (0.6)
Other
13 (2.6)
Urinary pathogen
Value, n (%)
E.coli
122 (24.4)
Enterococcus
31 (6.2)
Klebsiella
30 (6.0)
Proteus
9 (1.8)
Enterobacter
8 (1.6)
Pseudomonas aeruginosa
8 (1.6)
Staphylococcus aureus
6 (1.2)
Citrobacter
2 (0.4)
Streptococcus
2 (0.4)
Bacillus
1 (0.2)
Candida
1 (0.2)
Indication for urine culture following MCUG
Value, n (%)
Urinary symptom
13 (2.6)
Febrile
7 (1.4)
Non febrile
6 (1.2)
Non urinary symptom
9 (1.8)
Febrile
1 (0.2)
Non febrile
8 (1.6)
Routine testing
22 (4.4)
Febrile
0
Non febrile
22 (4.4)
Reason for urinalysis unknown
8 (1.6)
Febrile
0
Non febrile
8 (1.6)
Patient variable
Culture positive UTI 0-7 days post MCUG (n=17)
Culture positive UTI 8-14 days post MCUG (n=11)
Culture positive UTI 0-14 days post MCUG (n=24)
Empty Cell
n (%)
p-Value
n (%)
p-Value
n (%)
p-Value
Age, month
0-12
11 (2.2)
7 (1.4)
16 (3.2)
13-60
2 (0.4)
0.68
1 (0.2)
0.564
3 (0.6)
0.770
>60
4 (0.8)
3 (0.6)
5 (1.0)
Gender
Male
9 (1.8)
2 (0.4)
10 (2.0)
Female
8 (1.6)
0.849
9 (1.8)
0.015
14 (2.8)
0.172
Admission status
Inpatient
5 (1.0)
4 (0.8)
7 (1.4)
Outpatient
12 (2.4)
0.453
7 (1.4)
0.269
17 (3.4)
0.385
Indicationa
Previous history of UTI
12 (2.4)
0.012
9 (1.8)
0.010
18 (3.6)
0.001
Antenatal hydronephrosis
6 (1.2)
0.767
1 (0.2)
0.187
7 (1.4)
0.760
Neurogenic bladder
4 (0.8)
0.049
3 (0.6)
0.060
5 (1.0)
0.028
Upper tract structural anatomical anomaly
2 (0.4)
1.000
2 (0.4)
0.654
4 (0.8)
0.760
Known VUR
2 (0.4)
0.258
2 (0.4)
0.129
3 (0.6)
0.156
Bladder dysfunction
1 (0.2)
1.000
0 (0.0)
1.000
0 (0.0)
0.244
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