Pyeloplasty with ureteral stent placement in children: Do prophylactic antibiotics serve a purpose?

Autor: Vidovic S; University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA. Electronic address: Sara.Vidovic@BSWHealth.Org., Hayes T; University of Tennessee Health Science Center, Memphis, TN, USA., Fowke J; University of Tennessee Health Science Center, Memphis, TN, USA., Cline JK; University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA., Cannon GM; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA., Colaco MA; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA., Swords KA; University of California, San Diego/Rady Children's Hospital, San Diego, CA, USA., Cornwell LB; University of California, San Diego/Rady Children's Hospital, San Diego, CA, USA., Villanueva C; University of Nebraska Medical Center, Omaha, NE, USA., Corbett ST; University of Virginia Children's Hospital, Charlottesville, VA, USA., Maciolek K; University of Virginia Children's Hospital, Charlottesville, VA, USA., Lambert SM; Yale School of Medicine/Yale New Haven Health System, New Haven, CT, USA., Beltran G; Pediatric Urology Research Enterprise, Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA., Vemulakonda VM; Pediatric Urology Research Enterprise, Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA., Giel DW; University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2022 Dec; Vol. 18 (6), pp. 804-811. Date of Electronic Publication: 2022 Apr 11.
DOI: 10.1016/j.jpurol.2022.03.022
Abstrakt: Objectives: Ureteral stents are commonly used during pyeloplasty to ensure drainage and anastomotic healing. Antibiotic prophylaxis is often used due to concerns for urinary tract infection (UTI). Although many surgeons prescribe prophylactic antibiotics following pyeloplasty, practices vary widely due to lack of clear evidence-based guidelines. We hypothesize that the rate of stent UTI does not significantly vary between children who receive antibiotics and those who do not.
Methods: We reviewed the medical records of 741 patients undergoing pyeloplasty between January 2010 and July 2018 across seven institutions. Exclusion criteria were: age older than 22 years, no stent placed, externalized stents used, and incomplete records. Surgical approach, age, antibiotic use, stent duration, Foley duration, and urine culture results were recorded. Patients were categorized into two groups, those younger than four years of age and those four years and older as proxy for likely diaper use. Univariate logistic regression was conducted to identify variables associated with UTI. Multivariable backward stepwise logistic regression was used to identify the best model with Akaike information criterion as model selection criteria. The selected model was used to calculate odds ratios and 95% confidence intervals summarizing the association between prophylactic antibiotics and stent UTI while controlling for age, gender, and intra-operative urine cultures.
Results: 672 patients were included; 338 received antibiotic prophylaxis and 334 did not. These groups differed in mean age (3.91 vs. 6.91 years, P < .001), mean stent duration (38.5 vs. 35.32 days, P < .001), and surgical approach (53.25% vs. 32.04% open vs. laparoscopic, P < .001). The incidence of stent UTI was low overall (7.59%) and similar in both groups: 31/338 (9.17%) in the prophylaxis group and 20/334 (5.99%) in the non-prophylaxis group (P = .119). Although female gender, likely diaper use, and positive intra-operative urine culture were each associated with significantly higher odds of stent UTI, prophylactic antibiotic use was not associated with significant reduction in stent UTI in any of these groups. Surgical approach, stent duration, and Foley duration were not associated with stent UTI.
Conclusion: Incidence of stent UTI is low overall following pyeloplasty. Prophylactic antibiotics are not associated with lower rates of stent UTI following pyeloplasty even after controlling for risk factors of female gender, likely diaper use, and positive intra-operative urine culture. Routine administration of prophylactic antibiotics after pyeloplasty does not appear to be beneficial, and may be best reserved for those with multiple risk factors for UTI.
Competing Interests: Conflict of interest We have no conflicts of interest to disclose.
(Copyright © 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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