Yang Shuhan,Yu Xianhai,Cui Kongkong,et al.Analysis of risk factors for urinary tract infections in children with neurogenic bladder[J].Journal of Clinical Pediatric Surgery,2025,(05):436-441.[doi:10.3760/cma.j.cn101785-202502050-008]
Analysis of risk factors for urinary tract infections in children with neurogenic bladder
- Keywords:
- Urinary Bladder; Neurogenic; Urinary Tract Infections; Risk Factors; Child
- Abstract:
- Objective To identify the risk factors of urinary tract infection (UTI) in children with neurogenic bladder (NB) and provide scientific rationales for its proper clinical management. Methods A total of 169 hospitalized NB children were reviewed at Children’s Hospital of Chongqing Medical University from February 2015 to February 2023.Based upon the presence or absence of UTI,they were assigned into two groups of UTI (n=90) and non-UTI (n=79).Demographic profiles,clinical features (e.g.,gender,age,gestational age,disease duration,length of hospitalization,history of anorectal surgery,history of sacrococcygeal surgery,history of urinary system surgery,dysuria,frequent micturition & hydronephrosis) and laboratory results (e.g.,routine blood test,routine urine test,liver and kidney function test) were compared between two groups for identifying statistically significant parameters.Multifactorial Logistic regression analysis was performed for variables with significant differences to identify risk factors for UTI. Results Univariate analysis (using P<0.05 as a screening criterion) revealed that fever,history of urinary tract surgery,leukocyte,blood platelet,hemoglobin,urinary clarity,C-reactive protein,leukocyte and blood urea nitrogen (BUN) were associated with UTI in NB children.Excluding multicollinearity,multivariate Logistic regression analysis revealed that leukocyte,BUN,history of urinary tract surgery and hydronephrosis were the risk factors for UTI in NB children (P<0.05).Among them,the risk of UTI in children with elevated leukocyte was 13.367 folds higher than that in normal group (OR=13.367,95%CI: 3.732-47.878); the risk of UTI in children with elevated BUN was 1.102 folds higher than that in normal group (OR=1.102,95%CI: 1.019-1.193); children with a history of urinary tract surgery had a 2.118 folds higher risk (OR=2.118,95%CI: 0.999-4.490); the risk for those with hydronephrosis was 4.010 folds higher (OR=4.010,95%CI:1.857-8.658). Conclusions Leukocyte,BUN,history of urinary tract surgery and hydronephrosis are important risk factors for UTI in NB children and these parameters should be closely monitored in clinical practices.
References:
[1] Przydacz M,Chlosta P,Corcos J.Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury[J].Int Urol Nephrol,2018,50(6): 1005-1016.DOI: 10.1007/s11255-018-1852-7.
[2] Stauffer CE,Snyder E,Ngo TC,et al.Is neurogenic bladder a risk factor for febrile urinary tract infection after ureteroscopy and,if so,why?[J].Urology,2018,112: 33-37.DOI: 10.1016/j.urology.2017.10.006.
[3] 杨兴欢,陈燕,蒲青崧,等.儿童神经源性膀胱患者上尿路受损的危险因素及其预测价值研究[J].临床小儿外科杂志,2021,20(11):1005-1010.DOI: 10.12260/lcxewkzz.2021.11.002. Yang XH,Chen Y,Pu QS,et al.Risk factors and predictors of upper urinary tract damage in pediatric neurogenic bladder[J].DOI: 10.12260/lcx-ewkzz.2021.11.002.
[4] 李琦,蔡淼,吴盛德,等.神经源性膀胱上尿路损害的危险因素分析[J].临床小儿外科杂志,2022,21(3):253-257.DOI: 10.3760/cma.j.cn101785-202108049-010. Li Q,Cai M,Wu SD,et al.Analysis of risk factors for upper urinary tract injury in children with neurogenic bladder[J].J Clin Ped Sur,2022,21(3): 253-257.DOI: 10.3760/cma.j.cn101785-202108049-010.
[5] 中华人民共和国国家卫生健康委员会.儿童血细胞分析参考区间:WS/T 779-2021[S].北京:中国标准出版社,2021. National Health Commission of the People’s Republic of China.Reference intervals of blood cell analysis for children: WS/T 779-2021[S].Beijing: Standards Press of China,2021.
[6] Austin PF,Bauer SB,Bower W,et al.The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children’s Continence Society[J].Neurourol Urodyn,2016,35(4): 471-481.DOI: 10.1002/nau.22751.
[7] Latour K,De Lepeleire J,Catry B,et al.Nursing home residents with suspected urinary tract infections: a diagnostic accuracy study[J].BMC Geriatr,2022,22(1): 187.DOI: 10.1186/s12877-022-02866-2.
[8] Buettcher M,Trueck J,Niederer-Loher A,et al.Swiss consensus recommendations on urinary tract infections in children[J].Eur J Pediatr,2021,180(3): 663-674.DOI: 10.1007/s00431-020-03714-4.
[9] Ciarkowski CE,Imlay HN,Bryson-Cahn C,et al.Antimicrobial stewardship to reduce overtreatment of asymptomatic bacteriuria in critical access hospitals: measuring a quality improvement intervention[J].Infect Control Hosp Epidemiol,2025,46(2): 143-149.DOI: 10.1017/ice.2024.171.
[10] Hsiao CY,Chen TH,Lee YC,et al.Ureteral stone with hydronephrosis and urolithiasis alone are risk factors for acute kidney injury in patients with urinary tract infection[J].Sci Rep,2021,11(1): 23333.DOI: 10.1038/s41598-021-02647-8.
[11] Norman-Bruce H,Umana E,Mills C,et al.Diagnostic test accuracy of procalcitonin and C-reactive protein for predicting invasive and serious bacterial infections in young febrile infants: a systematic review and meta-analysis[J].Lancet Child Adolesc Health,2024,8(5): 358-368.DOI: 10.1016/s2352-4642(24)00021-x.
[12] Yu BZ,Chen ML,Zhang Y,et al.Diagnostic and prognostic value of interleukin-6 in emergency department sepsis patients[J].Infect Drug Resist,2022,15: 5557-5566.DOI: 10.2147/idr.S384351.
[13] Alrashid S,Ashoor R,Alruhaimi S,et al.Urinary tract infection as the diagnosis for admission through the emergency department: its prevalence,seasonality,diagnostic methods,and diagnostic decisions[J].Cureus,2022,14(8): e27808.DOI: 10.7759/cureus.27808.
[14] Froom P,Shimoni Z.Laboratory tests,bacterial resistance,and treatment options in adult patients hospitalized with a suspected urinary tract infection[J].Diagnostics (Basel),2024,14(11): 1078.DOI: 10.3390/diagnostics14111078.
Memo
收稿日期:2025-2-24。
基金项目:重庆市自然科学基金创新发展联合基金(市教委项目)(CSTB2024NSCQ-LZX0054)
通讯作者:魏光辉,Email:u806806@cqmu.edu.cn