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Factors associated with urinary tract infection after cystography in a contemporary pediatric population
Peter Y Cai1, Tanya Logvinenko1, Caitlynn Feng1
1Department of Urology, Boston Children's Hospital, Boston, MA, USA.
Insights
Urinary tract infections (UTIs) can occur after cystography in children. Circumcised males have a lower risk, while those with kidney stones have a higher risk. Prophylactic antibiotics did not reduce UTI rates.
Area of Science:
- Pediatric Urology
- Medical Imaging
- Infectious Disease
Background:
- Cystography is a common diagnostic imaging procedure in pediatric genitourinary evaluations.
- A known complication of cystography is iatrogenic urinary tract infection (UTI).
Purpose of the Study:
- To determine the incidence of post-cystography urinary tract infection (PCUTI) in a contemporary pediatric population.
- To identify factors associated with the development of PCUTI.
Main Methods:
- Retrospective review of 913 pediatric patients undergoing cystography.
- PCUTI defined by strict (fever/symptoms + pyuria + positive culture) or pragmatic (clinical suspicion) criteria within 30 days.
- Multivariate logistic regression used to analyze risk factors, including antibiotic prophylaxis.
Main Results:
- Strict criteria: 1.0% UTI within 7 days, 2.2% within 30 days. Pragmatic criteria: 3.6% UTI within 30 days.
- Circumcised males had lower odds of PCUTI (OR 0.24) compared to females.
- Presence of kidney stones on ultrasound significantly increased PCUTI likelihood (OR 12.2).
- Antibiotic prophylaxis was not associated with reduced PCUTI rates.
Conclusions:
- Circumcised males and children with kidney stones represent lower and higher risk groups for PCUTI, respectively.
- Prophylactic antibiotics did not demonstrate a significant reduction in PCUTI incidence.
- Further research is needed to identify effective interventions for reducing PCUTI in high-risk pediatric patients.
Background:
Cystography is a common genitourinary imaging study performed in the evaluation of children and can result in iatrogenic infection.
Objective:
We sought to determine the incidence of and factors associated with post-cystography urinary tract infection (PCUTI) in a contemporary population.
Study Design:
A single-institution, retrospective review was performed for 913 patients who underwent cystography (voiding cystourethrogram, radionuclide cystography, and contrast-enhanced voiding urosonography). PCUTI was defined as strict (fever or symptoms + pyuria + positive urine culture) or pragmatic (met strict criteria or high clinical suspicion prompting treatment) within 30 days of cystography. A multivariate logistic regression model was used to adjust for the propensity of being on antibiotic prophylaxis.
Results:
By strict criteria, 1.0 % and 2.2 % of patients developed PCUTI within 7 and 30 days of cystography, respectively. An additional 13 patients (33 total, 3.6 %) met pragmatic criteria for 30-day PCUTI. Circumcised males were less likely than females (OR 0.24, 95 % CI 0.05-0.76, p = 0.030) and patients with kidney stones on ultrasound were more likely than those without stones (OR 12.2, 95 % CI 3.04-42.34, p < 0.001) to have PCUTI. Being on antibiotic prophylaxis was not associated with decreased odds for post-cystography urinary tract infection.
Discussion:
Based on our results, we can reasonably counsel families that circumcised males have lower likelihood of PCUTI, children with kidney stones on their ultrasound have higher likelihood of PCUTI, and prophylactic antibiotics did not reduce the likelihood of developing a PCUTI. This study is limited by our pragmatic definition of UTI and the variables included in our multivariate model.
Conclusions:
There is a relatively small but noteworthy risk for urinary tract infection after cystography. Sex, circumcision status, and presence of kidney stones on ultrasound were significantly associated with the likelihood of PCUTI, while antibiotic prophylaxis was not. Further investigation is necessary to determine interventions that may reduce PCUTI in high-risk patients.
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