Risk Factors for Recurrent Urinary Tract Infection in Children With Neurogenic Bladder Following Clean Intermittent Catheterization

Abstract

Objective: To investigate the risk factors for recurrent urinary tract infection (UTI) in children with a neurogenic bladder (NB) managed by clean intermittent catheterization.

Materials and methods: Over a 5-year period, we retrospectively assessed the risk factors for recurrent UTIs in children (age 9-151 months) who had clean intermittent catheterization. All patients were followed up for more than 12 months and had at least two clinic visits during the study period. Demographic, clinical, and urodynamic parameters were assessed. All data were compared between the recurrent UTI (>1.0 UTI/study-year) and episodic UTI (≤1.0 UTI/study-year) groups.

Results: Of 327 patients, 79 (24.2%) had recurrent UTIs and 248 (75.8%) had episodic UTIs. Univariate and multivariate analyses showed that older age, lumbar level lesions, long duration of NB, presence of vesicoureteral reflux, increased bladder wall thickness, and low bladder compliance were the significant factors for recurrent UTIs. Bladder trabeculation was associated with recurrent UTIs on univariate analysis, but not on multivariate analysis. During the follow-up period, chronic renal insufficiency was diagnosed in 31 (39.2%) and 29 patients (11.7%) in the recurrent and episodic UTI groups (P <.05), respectively.

Conclusion: These results suggest that older age, high level of spinal cord lesions, long duration of NB, vesicoureteral reflux, increased bladder wall thickness, and low bladder compliance may be directly associated with recurrent UTIs in children with NB. Children with NB might have higher susceptibility to chronic renal insufficiency after recurrent UTIs.