Home screening for bacteriuria in children with spina bifida and clean intermittent catheterization
1 Department of Pediatrics, Máxima Medical Center Veldhoven, The Netherlands and Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
3 Department of Pediatrics, University Hospital Leuven, Leuven, Belgium
4 Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
5 Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
6 Máxima Medical Center, Department of Pediatrics, PO Box 7777, 5500, MB, Veldhoven, The Netherlands
BMC Infectious Diseases 2012, 12:264 doi:10.1186/1471-2334-12-264Published: 20 October 2012
Significant bacteriuria (SBU) and urinary tract infections (UTIs) are common in patients with spina bifida and neuropathic detrusor sphincter dysfunction. Laboratory agar plated culture is the gold standard to establish SBU. It has the disadvantage of diagnostic and subsequent therapeutic delay. Leukocyte esterase tests (LETs) and dip slides proved to be useful in the general populations to exclude SBU and UTI. The aim of this study was to evaluate the reliability of LET and dip slide in children with spina bifida without symptoms of UTI. The reliability in children with asymptomatic SBU was not studied before.
In one hundred and twelve children with spina bifida on clean intermittent catheterization LETs and dip slides were compared with laboratory cultures. Both tests and agar plated cultures were performed on catheterized urine samples. The hypothesis was that the home tests are as accurate as laboratory cultures.
A SBU was found in 45 (40%) of the 112 laboratory cultures. A negative LET excluded SBU (negative predictive value 96%), while a positive LET had a positive predictive value of 72%. The false positive rate was 28%. Dip slide determination of bacterial growth had no added value, other than serving as transport medium.
In spina bifida children, leukocyte esterase testing can be used to exclude significant bacteriuria at home, while dip slide tests have no added value to diagnose or exclude significant bacteriuria.