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| Culture-positive urinary tract infection following micturating cystourethrogram in children |
Simeon Ngwesoa,b,*( ),Munyaradzi Nyandoroa,Tatenda Nzenzab,c,Ting Yi Cheowd,Fiona Bettenaye,Andrew Barkere,Japinder Khosae,Naeem Samnakaye,f
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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 |
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Abstract 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.
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Available online: 20 July 2022
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Corresponding Authors:
Simeon Ngweso
E-mail: s.ngweso@gmail.com
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| Patient characteristic | Value, n (%) | | Age in months at time of micturating cystourethrogram | | 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 micturating cystourethrogram | | 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) |
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Patient demographics and indication for micturating cystourethrogram.
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| 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) |
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Urine culture results of patients who had culture-positive urinary tract infection before micturating cystourethrogram.
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| 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) |
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Indication for performing urine culture within 14 days following micturating cystourethrogram.
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| 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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Univariate analysis of patient subgroups—with likelihood of UTI post MCUG as the dependent variable.
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