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CONGRESS OF THE ESPU
15:44–15:47
S2-4 (PP)
ALTERED URINARY ANTIMICROBIAL PEPTIDES
IN THE NEUROGENIC BLADDER POPULATION
Janae PREECE
1
, Sudipti GUPTA
2
, Joshua WATSON
3
, Cheryl BAXTER
4
,
Stephanie RIESENBERG
2
, Andria HAYNES
4
, Brian BECKNELL
5
and Christina CHING
4
1) Children’s Hospital of Michigan, Urology, Detroit, USA - 2) Nationwide Children’s Hospital, Columbus, USA -
3) Nationwide Children’s Hospital, Infectious Disease, Columbus, USA - 4) Nationwide Children’s Hospital, Urology,
Columbus, USA - 5) Nationwide Children’s Hospital, Nephrology, Columbus, USA
PURPOSE
Bacteriuria is common in the neurogenic bladder population; thus differentiating between coloniza-
tion and infection is challenging. Overtreatment of colonization has led to resistant bacteria compli-
cating eradication of true infections. We evaluated urinary antimicrobial peptides (AMPs) expression
in neurogenic bladders in order to differentiate between colonization and infection.
MATERIAL AND METHODS
Urine was prospectively collected by void or catheterization from patients with known spinal cord
abnormalities (myelomeningocele or spinal cord injury) at time of renal ultrasound or urodynamics
(UDS) with IRB approval. Patients with augmentation cystoplasty were excluded. Control urine
was obtained from patients without spinal cord abnormality, urinary tract obstruction, or infection.
Samples were classified as infected, colonized, or sterile based on urinalysis, urine culture, and
symptomatology. AMP levels were measured by ELISAand normalized to urine creatinine. Ap‑value
of <0.05 was considered significant.
RESULTS
We evaluated 38 neurogenic samples and 17 controls. There was no difference in mean age be-
tween the neurogenic and control groups (11.0 vs. 12.9 years old, respectively, p=0.31) or gender
(14 males vs. 11 males, respectively, p=0.08). 11 neurogenic samples were sterile, 19 colonized,
and 8 infected. The antimicrobial peptides HIP/PAP, NGAL, and BD-1 were elevated in cases of UTI
when compared to colonization in neurogenic samples, though not significantly so. Interestingly,
HIP/PAP and LL-37 in sterile neurogenic samples were significantly higher than in sterile non-
neurogenic control samples (p=0.016 and 0.001, respectively).
CONCLUSIONS
Sterile urine from neurogenic bladders have significantly elevated urinary AMP levels compared to
controls and may suggest a broader role for AMPs in this patient population. Urinary AMPs may aid
in differentiating true infection from colonization in neurogenic patients.