routine screening and treatment of urinary tract infection may be justified in children and adolescents with cerebral palsy: a systematic review

Context: children and adolescents with cerebral palsy may present with lower urinary tract dysfunction which increases their risk for urinary tract infection (uti). whereas few studies reported low prevalence rates of uti in these patients, several studies documented high prevalence rates. thus, it appears there is no unanimity about the burden of uti in affected children and adolescents to justify routine screening and treatment of the infection. this systematic review aims to determine the risk and pooled prevalence rate of uti in children and adolescents with cerebral palsy. evidence acquisition: using appropriate descriptors, we searched the pubmed and google scholar databases. eligible papers were primary studies published in english language: reporting an association between cerebral palsy and uti or uti prevalence in children and adolescents with cerebral palsy and healthy comparators, with a clear definition of uti and cerebral palsy. we assessed the quality of included studies with the newcastleottawa scale (nos) and resolved interrater discrepancies by consensus. we independently retrieved relevant data from these studies using a preconceived dataextraction form. we analyzed the aggregate data on uti prevalence in these pediatric patients, using the log odds ratio (or) at 95% confidence interval as the summary estimate. results: of the seven included studies, only two (28.6%) were casecontrol studies, while five (71.4%) were crosssectional studies. there was no uniform definition of uti in these studies. prevalence rates varied widely from as low as 2.2% to as high as 56.7%. the mean uti prevalence rate estimated for six of the included studies was 31.8%.the log or at 95% ci computed for the casecontrol studies was 10.9 (95% ci: 9.0, 12.9). conclusions: the prevalence and risk of uti in children and adolescents with cerebral palsy are significantly high.routine screening and treatment for uti may be justified in these pediatric patients. we however recommend more prospective casecontrol studies to strengthen the current evidence of the high uti burden in these patients.