Diagnostic accuracy of urinalysis parameters for urinary tract infection in children with neurogenic bladder on clean intermittent catheterization: a retrospective cohort study
European Society for Emergency Medicine Congress 2026 (EUSEM 2026), Paris, Fransa, 24 - 27 Eylül 2026, ss.1, (Özet Bildiri)
- Yayın Türü: Bildiri / Özet Bildiri
- Basıldığı Şehir: Paris
- Basıldığı Ülke: Fransa
- Sayfa Sayıları: ss.1
- Eskişehir Osmangazi Üniversitesi Adresli: Evet
Özet
Introduction: Neurogenic bladder in children, predominantly caused by spina bifida and spinal cord injury, is commonly managed with clean intermittent catheterization (CIC), which substantially increases urinary tract infection (UTI) risk. Concurrent neurological deficits often prevent these children from expressing classic UTI symptoms, making culture-dependent diagnosis essential.. This study aimed to evaluate the diagnostic performance of urinalysis parameters for UTI diagnosis, using urine culture as the reference standard.
Material and Methods: Single-center retrospective cohort study. The study was approved by the institutional ethics committee. We analyzed 545 urine samples from children aged 0–17 years with neurogenic bladder on CIC presenting with suspected UTI (2014–2024). Urine culture was the reference standard (positive: single organism ≥10⁵ CFU/mL). Parameters included nitrite, leukocyte esterase (LE; ordinal), microscopic leukocyte count, bacterial count (≥1, ≥5, ≥10/field), urine clarity, and five combined models. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR+/LR−) with 95% Wilson confidence intervals were calculated; ROC analysis determined optimal cutoffs.
Results: Culture positivity was 28.1% (153/545). Complete diagnostic performance metrics are provided in Table 1. Nitrite showed the highest specificity (86.6%) and LR+ (3.85) but sensitivity of only 51.4%. No single parameter exceeded a PPV of 62% or specificity of 87%. Among combined models, 'Nitrite OR LE ≥1+' reached sensitivity 88.4% and NPV 91.4% (LR− 0.235). The strongest rule-out was 'LE ≥1+ OR Bacteria ≥1' (sensitivity 95.9%, NPV 95.8%, LR− 0.109). 'Nitrite AND LE ≥1+' provided the highest specificity (89.3%) and LR+ (3.90) (Table1).
Conclusions: Conventional urinalysis has significant diagnostic limitations for UTI in children with neurogenic bladder on CIC. Combined negativity of leukocyte esterase and bacteria provides a clinically actionable rule-out decision point (LR− 0.109), supporting antibiotic stewardship while awaiting culture results. Universally limited PPV reflects structural confounding by chronic colonization and asymptomatic bacteriuria inherent to this population.