A case of megacystis-megaureter syndrome with Pseudomonas aeruginosa urosepsis after bladder catheterization

Abstract

We report a 5-month-old boy with megacystis-megaureter syndrome who developed urosepsis after bladder catheterization. Bilateral hydronephrosis, megaureter, and megalocystis were found by prenatal ultrasonography. After birth, bilateral grade V vesicourethral reflux (VUR) was detected by voiding cystourethrogram. Prophylaxis with cefaclor 5 mg/kg/day was initiated. At age 5 months, intravenous pyelography (IVP) with bladder catheterization was performed for preoperative assessment. On the next day, he developed fever and urinalysis showed leukocyturia. Gram-negative rods were detected in his urine, and antibiotic treatment was started. Subsequently, both urine and blood culture grew P. aeruginosa. After 2 weeks of treatment, he was scheduled for the surgery to correct VUR and discharged. Given that he developed fever on the next day of IVP, we think that bladder catheterization triggered the infection. We propose that bag urine culture before bladder catheterlization and prophylactic antibiotics for the cultured bacteria, if needed, are useful.