598 - Identifying clinical predictors of negative urine testing in children with spina bifida

Publication Number: 2583.598

Alexandra Vincent, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; David I.. Chu, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Catherine S.. Forster, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Background: Urinary tract infections (UTIs) are common, but overdiagnosed, in children with spina bifida. There is no standardized definition of UTIs in spina bifida, in part because children with spina bifida can have pyuria and bacteriuria in the absence of a true symptomatic UTI. Determining the population characteristics with the lowest pre-test probability for UTI can reduce unnecessary antibiotic use through improved diagnostic stewardship.

Objective: The primary objective of this study was to determine the association between clinical predictors and the outcome of negative urine studies in children with spina bifida.

Design/Methods: This was a retrospective cohort study of children with spina bifida. We included children with myelomeningocele aged < 19 years who had a paired urinalysis (UA) and urine culture sent between January 1, 2016, to December 31, 2021 at one of two academic medical centers. We collected symptoms and other relevant covariates by chart review. Our primary outcome was negative urine studies, defined as no signs of urinary tract inflammation (either less than 1+ leukocyte esterase or less than 10 WBC) and negative culture. We used a multivariable logistic regression model to determine the association between clinical predictors and negative urine studies.

Results: We included a total of 974 encounters from 319 unique patients. The most common three symptoms in our cohort were fever (21.5%), malodorous urine (18.6%), and abdominal pain (16%). Significant predictors included age, sex, use of clean intermittent catheterization (CIC), fever, and malodorous urine. Male sex was associated with increased odds of negative urine studies (aOR 1.85 (95%CI 1.39-2.46)), while older age (aOR 0.92 (0.89-0.95)), malodorous urine (aOR 0.38 (0.24-0.58)), CIC (aOR 0.40 (0.28-0.57)) and fever (aOR 0.60 (0.42-0.86)) were associated with decreased odds of negative urine studies.

Conclusion(s): Male sex was directly associated with negative urine studies in children with spina bifida while older age, CIC, fever, and malodorous urine were inversely associated. These results may help inform children with spina bifida who do not warrant diagnostic evaluation for UTI.

Table 1
Clinical predictors of normal urine testing