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Effect of continuous antibiotic prophylaxis in children with postoperative JJ stents: A prospective randomized study
Aykut Akinci1, Eralp Kubilay2, Vahid Talha Solak2
1Department of Pediatric Urology, Ankara University School of Medicine, Cebeci Children's Hospital, Ankara, Turkey.
Insights
Continuous antibiotic prophylaxis (CAP) significantly reduced febrile urinary tract infections in children with JJ stents. This benefit was most pronounced in those with a prior history of infections or lower urinary tract symptoms.
Area of Science:
- Pediatric Urology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Urinary tract infections (UTIs) are a common complication in patients with indwelling ureteral stents.
- Continuous antibiotic prophylaxis (CAP) is sometimes used to prevent UTIs, but its effectiveness in patients with JJ stents requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of CAP in reducing febrile UTIs in pediatric patients with JJ stents.
- To identify specific patient subgroups that may benefit most from CAP.
Main Methods:
- A prospective, randomized, controlled study involving 105 pediatric patients undergoing procedures with JJ stents.
- Patients were randomized to receive CAP or no CAP. Febrile UTIs and urine cultures were compared between groups.
- Exclusion criteria included external stents, nephrostomy tubes, and long-term urethral catheters. History of UTIs and lower urinary tract symptoms (LUTS) were recorded.
Main Results:
- CAP significantly reduced the incidence of febrile UTIs (3.8% in CAP group vs. 19% in control group, p=0.015).
- Multivariate analysis indicated that a history of preoperative febrile UTIs and/or LUTS were significant predictors of post-stent infection.
- The mean duration of JJ stent placement was similar between groups (16.34 days vs. 15.29 days).
Conclusions:
- Continuous antibiotic prophylaxis is effective in decreasing the incidence of febrile UTIs in pediatric patients with JJ stents.
- Patients with a prior history of febrile UTIs and/or LUTS are at higher risk and may particularly benefit from CAP during JJ stent placement.
Objective:
We aimed to investigate the effectiveness of continuous antibiotic prophylaxis (CAP) in patients with JJ stent and tried to identify the group that could specifically benefit from CAP by a prospective randomized study.
Methods:
A prospective, randomized, controlled, non-blind, non-placebo study was performed in a single center.A total of 105 patients who underwent surgery with JJ stent (PNL, URS, pyeloplasty, UNC) were randomized into two groups. 53 patients in Group A received CAP and 52 patients in Group B were controlled without CAP, during the presence of a JJ stent. Patients with external stents, nephrostomy tubes, indwelling long-term urethral catheters were excluded. History of preoperative use of CAP and lower urinary tract symptoms were noted. Trimethoprim/sulfamethoxazole (TMP/SMX) was used as the initial choice of antibiotic however if there was a history of antibiotic resistance in previous urinary cultures, Nitrofurantoin was administrated. Urinary cultures were obtained before surgery and before stent extraction. JJ stents were sent to culture. Symptomatic febrile urinary tract infections with positive urine cultures (105 CFU on a clean catch or 103with urethral catheterization) were compared between groups.
Discussion:
Our study has some limitations; the study is the single-center, we did not follow-up of patients in terms of scar, there were low number of uncircumcised patients, multiple types of surgical procedures were performed. JJ stent is a frequently used instrument in children. Unfortunately, any randomized prospective on antibiotics administration while using a JJ stent is not available in the current literature. We hope our research will contribute to the existing literature and cause a significant change in clinical practice.
Results:
The mean age among all patients was 4.8 ± 3.9 years. The mean length of time jj stents stayed inside was 16.34 ± 6.45 days in group A and 15.29 ± 7.71 days in group B. The incidence of febrile urinary tract infections with CAP was significantly reduced (3.8% vs. 19% (p 0.015)). Multivariate regression analysis revealed that a positive history for preop febrile urinary tract infections and/or LUTS has a significantly higher association with the incidence of febrile urinary tract infecitons.
Conclusions:
CAP in the presence of JJ stents reduced the incidence of febrile urinary tract infections in a short period, especially in children with the previous history of febrile urinary tract infections and lower urinary tract symptoms.
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