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Contemporary Analysis of 30-Day UTI Rates Post-ureteral Reimplantation in VUR Patients: Evaluating the Role of
John Pfail1, Rachel Passarelli1, Charles Concodora1
1Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.
Insights
Discharge antibiotics do not significantly impact 30-day urinary tract infection (UTI) risk in children after ureteral reimplantation for vesicoureteral reflux (VUR). Age and female sex are key predictors of UTI in these pediatric patients.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Infectious Disease Prevention
Background:
- Vesicoureteral reflux (VUR) is a common condition in children, often managed with ureteral reimplantation surgery.
- Postoperative urinary tract infections (UTIs) are a concern following this procedure.
- The role of prophylactic antibiotics after discharge remains debated.
Purpose of the Study:
- To evaluate the impact of discharge antibiotics on 30-day postoperative UTI rates in pediatric patients undergoing ureteral reimplantation for VUR.
- To identify independent predictors of UTIs in this patient population.
Main Methods:
- Retrospective cohort study using the pediatric National Surgical Quality Improvement Program VUR-specific dataset.
- Analysis of 3004 patients who underwent ureteral reimplantation for VUR.
- Comparison of 30-day UTI rates, readmissions, and ER visits between patients discharged with and without antibiotics, using multivariable logistic regression.
Main Results:
- No significant difference in 30-day UTI rates (2.4% vs 3.2%), readmissions, or ER visits between groups receiving or not receiving discharge antibiotics.
- Age and female sex were identified as significant predictors of postoperative UTIs.
- Discharge antibiotic prescription did not demonstrate a significant impact on UTI rates.
Conclusions:
- Postoperative UTI risk within 30 days of ureteral reimplantation for VUR is primarily predicted by patient age and sex.
- Routine prophylactic antibiotic administration at discharge does not appear to reduce early UTI risk.
- Findings support antibiotic stewardship and can inform tailored postoperative care strategies in pediatric urology.
Objective:
To evaluate 30-day postoperative urinary tract infection (UTI) rates in children with vesicoureteral reflux (VUR) undergoing ureteral reimplantation, assessing the impact of discharge antibiotics.
Methods:
This retrospective cohort study utilized the pediatric National Surgical Quality Improvement Program VUR-specific dataset to analyze patients who underwent ureteral reimplantation for VUR. We compared 30-day UTI rates, readmissions, and ER visits between those discharged with and without antibiotics. Multivariable logistic regression identified independent predictors of UTIs.
Results:
Of the 3004 patients included who underwent ureteral reimplant, 2509 (84%) and 495 (16%) were discharged with or without antibiotics, respectively. On univariable analysis, the proportion of patients who experienced 30-day readmission (3.9% vs 5.3%), emergency room visits (10.5% vs 10.5%), and UTI (2.4% vs 3.2%) did not differ according to discharge antibiotic use (antibiotics vs no antibiotics, respectively, all P>.05). On MVA, age (Odds Ratio [OR]: 0.986, 95% CI: 0.978-0.994) and female sex (OR: 1.782, 95% CI: 1.005-3.162) were found to be significant predictors of UTI occurrence. Conversely, the prescription of antibiotics at discharge (OR: 1.564, 95% CI: 0.886-2.763) did not show a significant impact on UTI rates.
Conclusion:
Age and sex are predictive of UTI risk within 30 days following ureteral reimplantation for VUR. The absence of significant associations for reflux grade, perioperative stent use, or prophylactic antibiotic administration at discharge suggests that routine prescription of antibiotics post-discharge may not reduce early UTI risk. These findings can guide postoperative care and help tailor antibiotic stewardship efforts in pediatric urology.
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