The Challenge of Asymptomatic Bacteriuria and Symptomatic Urinary Tract Infections in Patients with Neurogenic Lower Urinary Tract Dysfunction.

We investigated prevalence of asymptomatic bacteriuria and incidence of symptomatic urinary tract infections (UTI) in patients with neurogenic lower urinary tract dysfunction (NLUTD) undergoing urodynamics and assessed predictors for symptomatic UTI.

A prospective consecutive series of 317 patients (106 women, 211 men) with NLUTD was evaluated. Of them, 111 (35%) voided spontaneously, 141 (44%) relied on intermittent self-catheterization and 65 (21%) on an indwelling catheter. Before urodynamics, urine samples were collected by sterile catheterization for dipstick testing and urine culture. We assessed the association between patient characteristics and the occurrence of symptomatic UTIs following urodynamics in patients with asymptomatic bacteriuria and developed a prediction model based on the most important risk factors.

Urine cultures before urodynamics were negative in 123 (39%) and positive in 194 (61%) patients. Escherichia coli (32%) and Klebsiella pneumoniae (18%) were the most frequent bacteria. Of 194 patients with positive culture, 35 (18%) had at least one symptomatic UTI. In patients with a history of previous UTIs, the overall estimated probability of a symptomatic UTI was 45%, irrespective of the underlying neurological disorder.

About one out of five patients with asymptomatic bacteriuria will develop a symptomatic UTI in the follow-up year. This rather low overall probability precludes routine antibiotic prophylaxis or treatment in patients with NLUTD having asymptomatic bacteriuria as 4 out of 5 patients would be overtreated. However, in patients with a history of previous symptomatic UTIs antibiotic prescription might be justified.

The Journal of urology. 2019 Sep 17 [Epub ahead of print]

Jure Tornic, Jens Wöllner, Lorenz Leitner, Ulrich Mehnert, Lucas M Bachmann, Thomas M Kessler

Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland., Medignition Inc., Research Consultants, Zürich, Switzerland.

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