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

PURPOSE 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. PATIENTS AND METHODS 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. RESULTS Urine cultures before urodynamics were negative in 123 (39%) and positive in 194 (61%) patients. (32%) and e (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. CONCLUSIONS 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.