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The association between continuous antibiotic prophylaxis and UTI from birth until initial postnatal imaging
B K Varda1, J B Finkelstein1, H-H Wang1
1Department of Urology, Boston Children's Hospital, Boston, MA, USA.
Insights
Continuous antibiotic prophylaxis (CAP) did not reduce urinary tract infection (UTI) rates in infants with antenatal urinary tract dilation (AUTD) before their first postnatal imaging. The incidence of UTI was low, suggesting limited benefit from routine CAP in this population.
Area of Science:
- Pediatric Nephrology
- Neonatal Care
- Infectious Diseases
Background:
- Consensus is lacking on continuous antibiotic prophylaxis (CAP) for infants with antenatal urinary tract dilation (AUTD) between birth and initial postnatal imaging.
- Urinary tract infections (UTIs) are a concern in this vulnerable population.
Purpose of the Study:
- To determine the incidence of UTI in infants with AUTD during the interval before their first postnatal renal ultrasound (RUS).
- To assess the association between CAP use and UTI development in these infants.
Main Methods:
- A retrospective cohort study analyzed 494 newborns with AUTD who underwent RUS within 3 months of birth.
- Data on CAP use, UTI occurrence, and clinical characteristics were collected via chart review.
- Propensity score adjusted logistic regression was used to analyze the association between CAP and UTI.
Main Results:
- Of 494 infants, 157 (32%) received CAP. Infants with higher UTD risk scores were more likely to receive CAP.
- Seven infants (1.4%) developed UTI before imaging; six without CAP and one with CAP.
- CAP use was not significantly associated with a reduced risk of UTI (adjusted odds ratio, 0.93; P = 0.95).
Conclusions:
- The incidence of UTI prior to initial neonatal imaging in newborns with AUTD is low.
- Continuous antibiotic prophylaxis (CAP) was not associated with a lower incidence of UTI in this cohort.
- Routine CAP use in newborns with AUTD before initial imaging may offer limited benefit.
Introduction:
There is a lack of consensus regarding the use of continuous antibiotic prophylaxis (CAP) during the interval between birth and initial postnatal imaging in infants with a history of antenatal urinary tract dilation (AUTD).
Objective:
To determine the incidence of urinary tract infection (UTI), and the association between CAP use and UTI during the interval between birth and the first postnatal renal ultrasound (RUS) in infants with AUTD.
Study Design:
A single-institution, retrospective cohort study of newborns with a history of AUTD. Infants undergoing RUS within 3 months of birth for an indication of 'hydronephrosis' between 2012 and 2014 were identified. A random sample of 500 infants was selected; six were excluded for concomitant congenital anomalies. Baseline patient (sex, race, insurance) and clinical characteristics (circumcision status, UTD risk score, receipt of CAP, UTI prior to RUS, age at UTI, and age at RUS) were collected via retrospective chart review. Descriptive statistics were calculated. To adjust for receipt of CAP, propensity score adjusted univariate logistic regression for UTI based on CAP status was performed.
Results:
Among the 494 infants with AUTD, 157 (32%) received CAP. Infants with normal/low-risk UTD scores were less likely to receive CAP than those with medium/high-risk UTD (23% vs 77%; P < 0.001). There was no difference in CAP based on sex, insurance, or circumcision status (among 260/365 males with known circumcision status). Overall, seven infants (1.4%) developed UTI prior to imaging: six (1.8%) without CAP vs one (0.64%) with CAP (P = 0.44). The median age at UTI was 59 days (range 2-84); among those with UTI, initial imaging occurred significantly later (66 vs 28 days; P = 0.001). The propensity score adjusted odds of developing UTI with CAP (vs without) was 0.93 (95% CI 0.10-8.32; P = 0.95). The Summary Figure describes the infants with UTI.
Conclusion:
The incidence of UTI prior to initial neonatal imaging in newborns with AUTD was low. Use of CAP was not associated with UTI incidence after adjusting for UTD severity. Routine use of CAP in newborns with AUTD prior to initial imaging may be of limited benefit in most patients.
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