Most children with neurogenic bladder (NGB) and diagnosed with febrile urinary tract infection (UTI) in the emergency department (ED) did not meet a commonly recommended definition for UTI, according to a study published online Sept. 15 in the Journal of Pediatric Urology.

Jacqueline G. Holden, from the University of Pittsburgh, and colleagues conducted a retrospective cohort study to assess the ED presentation and treatment of provider-diagnosed UTIs in children younger than 18 years old with NGB versus children with vesicoureteral reflux (VUR). The analysis included children with NGB or VUR diagnosed in the emergency department with a febrile UTI.

The researchers found that the most common symptom among all children was vomiting (38.8%). Of the children with NGB (215 children), 41.3% met the Urologic Management to Preserve Initial Renal Function definition for UTI. Compared with children with VUR, more children with NGB had multidrug-resistant organisms (MDROs) cultured from their urine. There were increased odds of MDRO in urine culture for children with NGB, both who did and did not require clean intermittent catheterization, versus those with VUR. Compared with children with VUR, children with NGB were more likely to be prescribed broad-spectrum antibiotics.

“The higher prevalence of MDRO UTIs and broad-spectrum antibiotic use in children with NGB highlights the need for accurate diagnostic approaches for UTI in this population, as well as the difficulty in diagnosing UTI in patients with NGB,” the authors write.

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