Pediatrics international : official journal of the Japan Pediatric Society · 2026
Urinalysis Abnormalities and Culture Positivity in Children With Clean Intermittent Catheterization.
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Kuas Nilsun, Gençler Aylin
Аннотация
BACKGROUND: Diagnosis of urinary tract infection (UTI) in children with neurogenic bladder is challenging due to frequent bacterial colonization and unreliable symptom assessment. This study aimed to evaluate the diagnostic performance of urinalysis parameters in predicting urine culture positivity in children undergoing clean intermittent catheterization (CIC).
METHODS: We retrospectively analyzed urine samples from children with neurogenic bladder who underwent CIC between 2015 and 2024. All samples were included regardless of symptom status. Urinalysis parameters, including leukocyte esterase (LE), nitrite, pyuria, and bacteriuria, were evaluated. Culture positivity was defined as growth of a single organism ≥ 105 CFU/mL. Generalized estimating equations were used to account for repeated measurements. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated for individual and combined parameters.
RESULTS: A total of 1362 urine samples from 107 patients were analyzed. The combination "Nitrite OR Bacteriuria" achieved the highest AUC (0.84), with sensitivity 0.85, specificity 0.84, PPV 0.84, NPV 0.85, and NLR 0.18. The three-parameter combination "LE OR Nitrite OR Bacteriuria" showed the highest sensitivity (0.94) and NPV (0.92), with an NLR of 0.10 indicating strong rule-out potential. Among AND-rule combinations, "LE AND Nitrite" showed the highest specificity (0.98) and PPV (0.93; PLR 14.27), but low sensitivity (0.36).
CONCLUSIONS: Urinalysis parameter combinations may help predict urine culture positivity (≥ 105 CFU/mL) in children undergoing CIC, though these findings cannot distinguish between asymptomatic bacteriuria and clinically significant UTI requiring treatment.
METHODS: We retrospectively analyzed urine samples from children with neurogenic bladder who underwent CIC between 2015 and 2024. All samples were included regardless of symptom status. Urinalysis parameters, including leukocyte esterase (LE), nitrite, pyuria, and bacteriuria, were evaluated. Culture positivity was defined as growth of a single organism ≥ 105 CFU/mL. Generalized estimating equations were used to account for repeated measurements. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated for individual and combined parameters.
RESULTS: A total of 1362 urine samples from 107 patients were analyzed. The combination "Nitrite OR Bacteriuria" achieved the highest AUC (0.84), with sensitivity 0.85, specificity 0.84, PPV 0.84, NPV 0.85, and NLR 0.18. The three-parameter combination "LE OR Nitrite OR Bacteriuria" showed the highest sensitivity (0.94) and NPV (0.92), with an NLR of 0.10 indicating strong rule-out potential. Among AND-rule combinations, "LE AND Nitrite" showed the highest specificity (0.98) and PPV (0.93; PLR 14.27), but low sensitivity (0.36).
CONCLUSIONS: Urinalysis parameter combinations may help predict urine culture positivity (≥ 105 CFU/mL) in children undergoing CIC, though these findings cannot distinguish between asymptomatic bacteriuria and clinically significant UTI requiring treatment.