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Published on: October 12, 2017
Occurrence of urinary tract infection in children with significant upper urinary tract obstruction
Christopher C Roth1, J Mikel Hubanks, Brianna C Bright
1Department of Urology, Children's Hospital of Oklahoma, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Insights
Urinary tract infections (UTIs) are uncommon in children with severe ureteropelvic junction obstruction or obstructive megaureter without antibiotic prophylaxis. Prophylactic antibiotics are likely unnecessary for most children with grade 3 or 4 hydronephrosis.
Area of Science:
- Pediatric Urology
- Nephrology
- Infectious Diseases
Background:
- Ureteropelvic junction obstruction and obstructive megaureter are primary causes of upper urinary tract obstruction in children.
- Previous studies indicated a high rate (>36%) of urinary tract infections (UTIs) in children with upper tract obstruction not receiving prophylactic antibiotics.
Purpose of the Study:
- To assess the incidence of UTIs in pediatric patients diagnosed with ureteropelvic junction obstruction and obstructive megaureter.
- To evaluate the necessity and role of prophylactic antibiotics in managing these conditions.
Main Methods:
- A retrospective analysis included 92 children with grade 3 or 4 hydronephrosis due to ureteropelvic junction obstruction or obstructive megaureter, who were not on prophylactic antibiotics.
- Urinary tract infection was defined as a symptomatic, culture-documented infection.
- Statistical analysis using Fisher's exact tests examined associations between UTI occurrence and factors like sex, obstruction level, hydronephrosis grade, and circumcision status.
Main Results:
- The overall UTI rate in the study cohort was low at 4.3% (95% CI 0.2%-8.6%).
- No statistically significant differences in UTI rates were observed based on sex, level of obstruction, grade of hydronephrosis, or circumcision status.
Conclusions:
- Antenatally diagnosed upper tract obstruction (grade 3-4 hydronephrosis) in children not receiving prophylactic antibiotics is associated with a low incidence of UTIs.
- Prophylactic antibiotic therapy is unlikely to be beneficial for the majority of children presenting with these specific upper urinary tract obstruction characteristics.
Objectives:
Ureteropelvic junction obstruction and obstructive megaureter are common causes of upper urinary tract obstruction. Recent data have demonstrated that the rate of urinary tract infection (UTI) among children with upper tract obstruction not treated with prophylactic antibiotics is >36%. The aim of this study was to evaluate the occurrence of UTI in our patients with ureteropelvic junction obstruction and megaureter to better assess the role of prophylactic antibiotics.
Methods:
A retrospective analysis was conducted. The inclusion criteria were grade 3 or 4 hydronephrosis secondary to obstructive megaureter or ureteropelvic junction obstruction in children not maintained on prophylactic antibiotics. UTI was defined as a culture-documented symptomatic infection. Fisher's exact tests were used to evaluate for an association between the occurrence of UTI with sex, level of obstruction, grade of hydronephrosis, and circumcision status.
Results:
A total of 92 patients met the study criteria. The rate of UTI in all patients was 4.3% (95% confidence interval 0.2%-8.6%). No statistically significant difference in the infection rate was noted according to sex, obstruction level, hydronephrosis grade, or circumcision status.
Conclusions:
Our results have demonstrated a low occurrence of UTI in antenatally diagnosed patients not maintained on antibiotics. We have concluded that antibiotic prophylaxis is unlikely to benefit most children with grade 3 or 4 hydronephrosis secondary to upper tract obstruction.
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