Diagnostic Accuracy of Urine Microbial Diversity and Urine NGAL for the Diagnosis of Urinary Tract Infections in Children with Spina Bifida

To assess the predictive accuracy of urine neutrophil gelatinase-associated lipocalin (NGAL) and the Shannon Diversity Index in diagnosing urinary tract infection (UTI) in children with spina bifida. Cross-sectional study of children with spina bifida who were evaluated for UTI in the emergency department. We included patients under the age of 22 years with spina bifida who used clean intermittent catheterization and had a urinalysis and urine culture sent. We measured urine NGAL and completed 16SrRNA sequencing. We generated receiver operating characteristic curves to assess the predictive accuracy of urinary NGAL and Shannon Diversity Index. There were 51 children, 13 with UTI, in this study. Median Shannon Diversity Index was lower in children with UTI compared with those without, while median NGAL was significantly higher in the UTI vs the no UTI group. The area under the curve for the combination of NGAL and Shannon Diversity was 0.88 (0.78-0.99), which is not significantly different from either the AUC for NGAL or Shannon Diversity Index alone. NGAL was more specific, while Shannon Diversity Index was more sensitive for the diagnosis of UTI. NGAL is specific, and Shannon Diversity Index is sensitive, for diagnosing UTI in children with spina bifida who use clean intermittent catheterization . However, the combination of the two markers does not have improved predictive accuracy over either alone.