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Risk Factors of Urinary Tract Infection in Pediatric Patients with Ureteropelvic Junction Obstruction after Primary
Hongyang Wang1, Chunsheng Hao1, Dongsheng Bai1
1Department of Urology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
Insights
Urinary tract infections (UTIs) are a risk after pyeloplasty for ureteropelvic junction obstruction (UPJO) in children. Male gender, younger age, lower weight and height, lower BMI, higher BUN, and internal drainage are key risk factors for post-operative UTI.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Infectious Disease
Background:
- Ureteropelvic junction obstruction (UPJO) is a primary cause of fetal hydronephrosis.
- UPJO is linked to urinary tract infections (UTIs) and urinary stone disease.
- Understanding UTI risk factors post-pyeloplasty is crucial for pediatric patient management.
Purpose of the Study:
- To identify risk factors for urinary tract infections (UTIs) in pediatric patients.
- To analyze UTI incidence following primary unilateral pyeloplasty for UPJO.
Main Methods:
- Retrospective review of 504 pediatric patients undergoing primary pyeloplasty (June 2015 - November 2021).
- Collected demographic and clinical data, including age, BMI, BUN, and surgical details.
- Analyzed incidence of postoperative UTIs and associated risk factors using univariate and multivariate analyses.
Main Results:
- 188 of 504 patients developed postoperative UTIs.
- Univariate analysis identified age, gender, weight, height, BMI, surgical modality, BUN, and drainage as associated factors.
- Multivariate analysis confirmed male gender, age <19 months, weight <11.5 kg, height <83 cm, BMI <17.09, BUN >4.08 mmol/L, and internal drainage as significant risk factors for UTI.
Conclusions:
- Identified specific demographic and clinical factors associated with increased UTI risk post-pyeloplasty in pediatric UPJO patients.
- Findings provide a basis for targeted prophylactic antibiotic strategies in high-risk pediatric patients.
- Highlights the importance of considering patient-specific factors in managing UPJO.
Objective:
Ureteropelvic junction obstruction (UPJO) represents to a leading cause of fetal hydronephrosis, which is associated with urinary tract infection (UTI) and urinary stone disease. This study is aimed at investigating risk factors of UTI in pediatric patients with UPJO after primary unilateral pyeloplasty.
Methods:
The records of a consecutive series of patients undergoing primary pyeloplasty at a single institution between June 2015 and November 2021 were retrospectively reviewed. Demographic and clinical characteristics, including age, gender, weight, height, body mass index (BMI), creatinine (Cr), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), neutrophil ratio, lymphocyte ratio, neutrophil/lymphocyte ratio, renal pelvis anteroposterior diameter (APD), renal cortex thickness, caliectasis, open or laparoscopic pyeloplasty, and internal drainage or external drainage, were collected and analyzed. The incidence of postoperative UTI and its risk factors was analyzed.
Results:
A total of 504 patients were enrolled in the study, and they were classified into the UTI group (n = 188) and non-UTI group (n = 361). Univariate analysis of the incidence of UTI revealed that age, gender, weight, height, BMI, surgical modality, Cr level, BUN level, neutrophil ratio, lymphocyte ratio and neutrophil/lymphocyte ratio, renal cortex thickness, and postoperative drainage modality were associated with UTI incidence after pyeloplasty in pediatric patients with UPJO. Multivariate analysis revealed that male gender, <19 months, weight < 11.5 (kg), height < 83 (cm), BMI < 17.09, BUN > 4.08 (mmol/L), and internal drainage were risk factors of postoperative UTI in pediatric patients with UPJO.
Conclusion:
Our study demonstrated that male gender, <19 months, weight < 11.5 (kg), height < 83 (cm), BMI < 17.09, BUN > 4.08 (mmol/L), and internal drainage were risk factors of UTI in pediatric patients with UPJO after primary unilateral pyeloplasty, which may provide reference for prophylactic antibiotics for those patients with risk factors.
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