Table 1 presents the sociodemographic characteristics of the children and caregivers who participated in the study. In the RAMACIC group, the mean age of the caregivers was 39.90 ± 5.91 years (27–48), the mean age of the children was 7.40 ± 4.23 years (3–18), and the mean daily CIC frequency was 5.35 ± 1.42 (3–10). In contrast, the mean age of the caregivers in the receiving routine hospital education was 36.80 ± 6.97 years (25–48), the mean age of the children was 9.40 ± 4.54 years (4–18), and the mean daily CIC frequency was 4.90 ± 1.25 (3–8) (Table 1).

RAMACIC groups, 80% of the children were girls, 60% had a medical diagnosis of SB, 95% were using antibiotics, 55% had a daily CIC frequency of 1–5, 95% were using diapers, 85% had fecal incontinence, and 55% had constipation. All of the caregivers in the experimental group were women, 95% were the mothers of the children, 80% lived in the town, 50% had less income than expenses and had primary education, and 75% lived in a nuclear family.

Routine training groups, 75% of the children were girls, 60% had a medical diagnosis of SB, all use antibiotics, 70% had a daily CIC frequency of 1–5, 90% were using diapers, 65% had fecal incontinence, and 60% had constipation. All of the caregivers in the routine training group were women, all of the child’s mother, 75% lived in the town, 30% had less income than expenses, 60%had primary education, and 80% lived in a nuclear family (Table 1).

In the study, the sociodemographic characteristics of the caregivers in the RAMACIC group and the group receiving routine training in the hospital were compared using the chi-square test for confounding factors such as gender, medical diagnosis, children having additional diseases, antibiotic use, fecal incontinence, and constipation. No significant difference was found between the two groups in the statistical analysis (Table 1).

In Table 2, the incidence of UTI in children over 2 years, categorized according to 6-month periods, the name of the causative bacteria, symptomatic UTI, antibiotic resistance, and ESBL positivity status, is compared in both groups.

During the first 6-month period, UTI incidence was 40% in children of caregivers receiving RAMACIC, compared with 75% in those receiving routine hospital education. The decrease in UTI incidence among the children of recipients receiving RAMACIC was statistically significant with a moderate effect size (r: 0.402, p < 0.026) (Table 2).

In the patients in the receiving RAMACIC group, 37.5% had symptomatic bacteriuria, 18.7% had antibiotic resistance, and 12.5% ​​were ESBL positive. The patients in the receiving routine hospital education group, 57.6% had symptomatic bacteriuria, 46.1% had antibiotic resistance, and 26.9% ​​were ESBL positive (Table 2).

At the end of the first 6 months, urine cultures of children of caregivers taking RAMACIC revealed growth of Escherichia coli in 50%, Klebsiella pneumoniae in 25%, Pseudomonas aeruginosa, and Enterococcus faecium in 12.5%. In contrast, 42.3% of the children in the routine education group exhibited Escherichia coli, 26.9% Klebsiella pneumoniae, 11.6% Pseudomonas aeruginosa, 15.3% Enterococcus faecium, and 3.9% Proteus mirabilis (Table 2).

In the second 6-month period, UTI incidence was 45% in the RAMACIC group and 80% in the routine education group. The decrease in UTI incidence among the RAMACIC group was statistically significant with a moderate effect size (r: 0.361, p < 0.022) (Table 2).

The patients in the receiving RAMACIC group, 11.8% had symptomatic bacteriuria, 35.3% had antibiotic resistance, and 29.5% ​​were ESBL positive. The patients in the receiving routine hospital education group, 26.5% had symptomatic bacteriuria, 29.5% had antibiotic resistance, and 35.3% ​​were ESBL positive. (Table 2).

At the end of the second 6 months, urine cultures of children of caregivers taking RAMACIC revealed growth of Escherichia coli in 52.9%, Klebsiella pneumonia in 17.6%, Pseudomonas aeruginosa and Enterococcus faecium in 11.7%, and 6.1% Proteus mirabilis. In contrast, 47.3% of the children in the routine education group exhibited Escherichia coli, 41.1% Klebsiella pneumoniae, 5.8% Pseudomonas aeruginosa, and 2.9% Enterococcus faecium and Proteus mirabilis (Table 2).

In the third 6-month period, the incidence of UTI in children of caregivers receiving RAMACIC was 30%, while in those undergoing routine training in the hospital, it was 70%. The decrease in UTI incidence among the RAMACIC group at the end of this period compared with the other group was significant with a moderate effect size (r: 0.503, p < 0.004) (Table 2).

The patients in the receiving RAMACIC group had no symptomatic bacteriuria; 14.3% had antibiotic resistance and ESBL positive. In the patients in the receiving routine hospital education group, 83.3% had symptomatic bacteriuria, 20% had antibiotic resistance, and 16.7% ​​were ESBL positive (Table 2).

Bacterial analysis revealed that Escherichia coli 28.6%, Klebsiella pneumonia 42.8%, and Staphylococcus aureus were present in 28.6% of the urine samples from the RAMACIC group. Conversely, children from the routine training group exhibited Escherichia coli in 63.3%, Klebsiella pneumonia in 23.3%, Pseudomonas aeruginosa in 10.0%, and Enterococcus faecium in 3.4% of their urine samples (Table 2).

During the fourth 6-month period, the incidence of UTI in children of caregivers receiving RAMACIC was 25%, while in those undergoing routine training in the hospital, it was 65%. The decrease in UTI incidence among the RAMACIC group at the end of this period compared with the other group was significant with a moderate effect size (r: 0.402, p < 0.011) (Table 2).

In the patients in the receiving RAMACIC group, 84.3% had symptomatic bacteriuria and 20% had antibiotic resistance and ESBL positive. In the patients in the receiving routine hospital education group, 60% had symptomatic bacteriuria, 20% had antibiotic resistance, and 16% ​​were ESBL positive (Table 2).

Bacterial analysis indicated that Escherichia coli in 83.4% and Klebsiella pneumonia in 16.6% were detected in the RAMACIC group, respectively. On the other hand, 36.2% of the children from the routine training group had Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa in 24.1%, and Proteus mirabilis and Enterococcus faecium in 7.8% in their urine samples (Table 2).

Table 3 compares the names of the causative bacteria of UTI, symptomatic UTI, antibiotic resistance, and ESBL positivity in children in both groups over 2 years. Escherichia coli was the most frequently isolated species in both groups. The distribution of bacterial growth in children whose caregivers received RAMACIC within 2 years included Escherichia coli (52.1%), Klebsiella pneumonia (23.9%), Pseudomonas aeruginosa (8.6%), Enterococcus faecium (8.6%), Proteus mirabilis (2.1%), and Staphylococcus aureus (4.7%). In contrast, in children whose caregivers received routine hospital training, Escherichia coli accounted for 53.3%, Klebsiella pneumonia (22.4%), Pseudomonas aeruginosa (13.5%), Enterococcus faecium (7.7%), and Proteus mirabilis (3.1%) (Table 3). Symptomatic UTI was seen in 28.2%, antibiotic resistance was seen in 23.9%, and ESBL positive was seen in 19.5% in the RAMACIC group over 2 years. On the other hand, in the group receiving routine training in the hospital, symptomatic UTI was seen at a rate of 55.6%, antibiotic resistance at a rate of 28.6%, and ESBL positivity at a rate of 25.9% over 2 years (Table 3).