Febrile Urinary Tract Infections in Children with Primary Non-Refluxing Megaureter: A Systematic Review and Meta-Analysis
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Published on: June 23, 2015
Katharina Rohner1, Sara Mazzi1, Kathrin Buder1
1Pediatric Nephrology, University Children's Hospital Zürich, Zurich, Switzerland.
Insights
The pooled prevalence of febrile urinary tract infections in children with primary non-refluxing megaureter is 14.35%. Continuous antibiotic prophylaxis may be beneficial for select patients to prevent infections.
Area of Science:
- Pediatric Urology
- Infectious Diseases
Background:
- Febrile urinary tract infections (UTIs) pose a risk to patients with primary non-refluxing megaureter (PNM).
- Understanding baseline UTI risk is crucial for guiding treatment decisions, including antibiotic prophylaxis.
Purpose of the Study:
- To determine the pooled prevalence of febrile UTIs in children with PNM managed non-surgically.
- To assess the potential value of continuous antibiotic prophylaxis for preventing febrile UTIs in this population.
Main Methods:
- A systematic review was conducted using MEDLINE, EMBASE, and Cochrane databases.
- Included studies followed Cochrane Collaboration and PRISMA guidelines.
- 16 studies with 749 patients were eligible for analysis.
Main Results:
- The overall pooled prevalence of febrile UTIs in patients with PNM was 14.35%.
- The number needed to treat with continuous antibiotic prophylaxis to prevent one UTI over 1-2 years was calculated as 4.3.
Conclusions:
- Continuous antibiotic prophylaxis should be considered for children with PNM undergoing non-surgical management.
- Prophylaxis may be particularly beneficial for infants, those with urinary outflow impairment, or higher-grade ureteral dilatation.
Background:
Knowledge of the baseline risk of febrile urinary tract infections in patients with primary non-refluxing megaureter can help clinicians to make informed decisions for offering continuous antibiotic prophylaxis.
Objective:
The primary objective of this systematic review was to determine the pooled prevalence of febrile urinary tract infections in patients with primary non-refluxing megaureter selected for primary non-surgical management independent of associated attributed risk factors at initial presentation in order to assess the value of continuous antibiotic prophylaxis.
Methods:
MEDLINE, EMBASE, and Cochrane Controlled Trials Register electronic databases were searched for eligible studies without language and time restriction. The systematic review was carried out following the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. (PROSPERO registration number CRD42018104752).
Results:
Of 25 871 records, 16 studies (n=749 patients) were eligible for inclusion. The overall pooled prevalence of febrile urinary tract infections in patients with primary non-refluxing megaureter was 14.35% (95% confidence interval: 8.8-22.6). The calculated number needed to treat for patients on continuous antibiotic prophylaxis to prevent one single febrile urinary tract infection over the course of 1-2 years would be 4.3.
Conclusion:
Based on the current available evidence the use of continuous antibiotic prophylaxis for children with PM selected for primary non-surgical treatment should be taken into consideration, at least in patients with urinary outflow impairment, higher grade of ureteral dilatation, and for children in the first months of life.
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