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Singh GK, Deshpande AV, Schlegel G, Starkey MR, Taghavi K. The rationale for bladder washouts in children with neurogenic bladder. Neurourol Urodyn 2024; 43:1019-1024. [PMID: 38516982 DOI: 10.1002/nau.25450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
Children with a neurogenic bladder are at risk of developing recurrent urinary tract infections and long-term kidney failure. Due to an altered lower urinary tract, children may be overtreated for simple bacteriuria or undertreated for a potentially severe urinary tract infection. This group of patients represent high users of healthcare, and are at risk of colonization and development of antibiotic resistance. Bladder washouts with non-antibiotic electrochemically activated solutions are a potential new prophylactic option for patients with bladder dysfunction when clean intermittent catheterization has resulted in chronic bacteriuria.
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Affiliation(s)
- Gopal-Krsna Singh
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Aniruddh V Deshpande
- Department of Urology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Center for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- School of Public Health, Westmead, New South Wales, Australia
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gemma Schlegel
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Malcolm Ronald Starkey
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kiarash Taghavi
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia
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Autore G, Bernardi L, Ghidini F, La Scola C, Berardi A, Biasucci G, Marchetti F, Pasini A, Capra ME, Castellini C, Cioni V, Cantatore S, Cella A, Cusenza F, De Fanti A, Della Casa Muttini E, Di Costanzo M, Dozza A, Gatti C, Malaventura C, Pierantoni L, Parente G, Pelusi G, Perrone S, Serra L, Torcetta F, Valletta E, Vergine G, Antodaro F, Bergomi A, Chiarlolanza J, Leoni L, Mazzini F, Sacchetti R, Suppiej A, Iughetti L, Pession A, Lima M, Esposito S. Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group. Antibiotics (Basel) 2023; 12:1040. [PMID: 37370359 DOI: 10.3390/antibiotics12061040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. Methods: A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results: The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended. Conclusions: Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk.
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Affiliation(s)
- Giovanni Autore
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Luca Bernardi
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Filippo Ghidini
- Pediatric Surgery, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Claudio La Scola
- Pediatric Clinic, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138 Bologna, Italy
| | - Alberto Berardi
- Neonatology and Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy
| | - Federico Marchetti
- Pediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Andrea Pasini
- Pediatric Clinic, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138 Bologna, Italy
| | - Maria Elena Capra
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy
| | | | - Vera Cioni
- Pediatric Unit, Sassuolo Hospital, AUSL Modena, 41049 Sassuolo, Italy
| | - Sante Cantatore
- Pediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Andrea Cella
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy
| | - Francesca Cusenza
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Alessandro De Fanti
- Pediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Elisa Della Casa Muttini
- Neonatology and Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | | | - Alessandra Dozza
- Pediatric Unit, Pavullo Hospital, AUSL Modena, 41026 Pavullo, Italy
| | - Claudia Gatti
- Pediatric Surgery, University Hospital, 43126 Parma, Italy
| | | | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138 Bologna, Italy
| | - Giovanni Parente
- Pediatric Surgery, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138 Bologna, Italy
| | - Gabriella Pelusi
- Pediatrics Surgery, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy
| | - Serafina Perrone
- Neonatology Unit, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Laura Serra
- Pediatric Unit, Imola Hospital, AUSL Imola, 40026 Imola, Italy
| | | | - Enrico Valletta
- Pediatric Unit, Forlì Hospital, AUSL Romagna, 47122 Forlì, Italy
| | - Gianluca Vergine
- Pediatric Clinic, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy
| | | | - Andrea Bergomi
- Primary Care Pediatrician, AUSL Modena, 41125 Modena, Italy
| | | | - Laura Leoni
- Primary Care Pediatrician, AUSL Parma, 43126 Parma, Italy
| | - Franco Mazzini
- Primary Care Pediatrician, AUSL Romagna, 47521 Cesena, Italy
| | | | - Agnese Suppiej
- Pediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
| | - Lorenzo Iughetti
- Pediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Andrea Pession
- Pediatric Clinic, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138 Bologna, Italy
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138 Bologna, Italy
| | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Jiang M, Deng J, Zhou G, Li S, Liu G. Risk factors for recurrent urinary tract infection in children with neurogenic bladder following clean intermittent catheterization. Urology 2022; 164:224-229. [PMID: 35026189 DOI: 10.1016/j.urology.2021.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the risk factors for recurrent urinary tract infection (UTI) in children with a neurogenic bladder (NB) managed by clean intermittent catheterization (CIC). METHODS Over a 5-year period, we retrospectively assessed the risk factors for recurrent UTIs in children (age 9-151 months) who had CIC. All patients were followed up for more than 12 months and had at least two clinic visits during the study period. Demographic, clinical, and urodynamic parameters were assessed. All data were compared between the recurrent UTI (>1.0 UTI/study-year) and episodic UTI (≤1.0 UTI/study-year) groups. RESULTS Of 327 patients, 79 (24.2%) had recurrent UTIs and 248 (75.8%) had episodic UTIs. Univariate and multivariate analyses showed that older age, lumbar level lesions, long duration of NB, presence of vesicoureteral reflux (VUR), increased bladder wall thickness (BWT), and low bladder compliance were the significant factors for recurrent UTIs. Bladder trabeculation was associated with recurrent UTIs on univariate analysis, but not on multivariate analysis. During the follow-up period, chronic renal insufficiency was diagnosed in 31 (39.2%) and 29 patients (11.7%) in the recurrent and episodic UTI groups (p<0.05), respectively. CONCLUSIONS These results suggest that older age, high level of spinal cord lesions, long duration of NB, VUR, increased BWT, and low bladder compliance may be directly associated with recurrent UTIs in children with NB. Children with NB might have higher susceptibility to chronic renal insufficiency after recurrent UTIs.
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Affiliation(s)
- Man Jiang
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Xicheng District, Beijing, China 100045; Department of Infectious Disease, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China 518000
| | - Jikui Deng
- Department of Infectious Disease, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China 518000
| | - Guanglun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China 518000
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China 518000
| | - Gang Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Xicheng District, Beijing, China 100045.
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The impact of constant antibiotic prophylaxis in children affected by spinal dysraphism performing clean intermittent catheterization: a 2-year monocentric retrospective analysis. Childs Nerv Syst 2022; 38:605-610. [PMID: 34523011 PMCID: PMC8917099 DOI: 10.1007/s00381-021-05337-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/14/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Spinal dysraphism (SD) is a general term used to refer to developmental abnormalities of the spine that involves many clinical conditions including myelomeningocele (MMC). In these patients, neurogenic bladder (NB) is a common and predisposing factor for renal damage; the most frequently used approach to manage this situation is based on clean intermittent catheterization (CIC) and anticholinergic drugs. Urinary tract infections (UTIs) are a significant concern for these patients, and antibiotic prophylaxis is frequently used even if it is still a debated topic of literature. The purpose of this paper is to investigate the role and the real effectiveness of antibiotic prophylaxis in the reduction of incidence of UTIs in patients with spina bifida performing CIC. METHODS We collected data of all patients performing CIC, who did their last follow-up visit in the period between January 2019 and January 2021, followed at the children multidisciplinary Spina Bifida Center of A. Gemelli Hospital in Rome. Data collected included age at referral, gender, type of SD lesion, serum creatinine and cystatin C levels, the use of anticholinergic medications, antibiotic prophylaxis and type of prophylaxis (oral/endovesical), age of starting prophylaxis with its duration/adherence, number of CIC/day and its duration, episodes of UTIs in the 2 years prior to the last follow-up, and presence and grade of vesical-ureteric reflux (VUR) on cystourethrogram. RESULTS A total of 121 patients with SD performing CIC was included in the study; 66 (54%) presented ≥ 1 episode of UTIs in the last two years and 55 (46%) none. During the study period, 85 (70%) patients received antibiotic prophylaxis (ABP group) and 36 (30%) did not (NABP group): no statistically significative difference in terms of UTI development was observed between the two groups (p = 0.17). We also evaluated compliance to the therapy; 71 patients (59%) took antibiotic prophylaxis constantly (CABP group) and 50 (41%) did not do antibiotic prophylaxis constantly or did not do antibiotic prophylaxis at all (NCABP group): we observed a statistically significative difference in terms of UTIs with a 2.2 times higher risk of development at least one episode of UTIs in NCABP group. CONCLUSION In conclusion, antibiotic prophylaxis performed constantly, without interruption, is associated with a lower risk of developing urinary tract infections and consequently to develop renal failure in adulthood.
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Multidrug-resistant organisms in urinary tract infections in children. Pediatr Nephrol 2020; 35:1563-1573. [PMID: 31418063 DOI: 10.1007/s00467-019-04316-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/10/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
The global spread of multidrug-resistant organisms has led to an increase in urinary tract infections (UTIs) in children that are difficult to treat. This review explores the current literature regarding multidrug-resistant UTIs in childhood and proposes an approach to management. Multidrug-resistant organisms include a wide range of potential urinary tract pathogens and, while most literature on drug resistance in UTIs during childhood has focused on extended-spectrum beta-lactamase producing organisms, in this review, we have included a discussion of multidrug resistance including and beyond beta-lactamase production. We provide definitions for multidrug-resistant organisms in line with current consensus guidelines and summarise clinically relevant mechanisms of resistance. Additionally, in this review, we outline the global epidemiology of multidrug-resistant UTIs in children, summarising published prevalence rates, which range from 5 to 90% in different settings. Finally, we also critically review the evidence on risk factors for colonisation and infection of the urinary tract with multidrug-resistant organisms, including prior antibiotic use, hospitalisation and underlying urological malformations. We also highlight multidrug-resistant UTI occurring in children without any identifiable risk factors, reflecting an increasing prevalence of colonisation with these organisms in the general community. Taken as a whole, this emphasises a need for careful and evidence-based use of antibiotics when treating UTIs in children and, to aide clinicians, we have outlined here potential management strategies for when infection with a multidrug-resistant organism is suspected or confirmed.
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6
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Antibiotic prophylaxis after urethroplasty may offer no benefit. World J Urol 2019; 38:1295-1301. [DOI: 10.1007/s00345-019-02880-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/18/2019] [Indexed: 01/28/2023] Open
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Khan A, Jhaveri R, Seed PC, Arshad M. Update on Associated Risk Factors, Diagnosis, and Management of Recurrent Urinary Tract Infections in Children. J Pediatric Infect Dis Soc 2019; 8:152-159. [PMID: 30053044 PMCID: PMC6510945 DOI: 10.1093/jpids/piy065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 07/19/2018] [Indexed: 01/16/2023]
Abstract
Recurrent urinary tract infection (rUTI) continues to challenge pediatric care providers. The diagnosis of an rUTI can be difficult, especially in young febrile children. Antibiotic resistance rates continue to rise, which limits oral treatment options. Prophylactic antibiotics are used commonly to manage rUTI, but their use increases the risk of rUTI with antibiotic-resistant strains without significantly reducing renal scarring. Alternative therapies for rUTI include probiotics and anthocyanidins (eg, cranberry extract) to reduce gut colonization by uropathogens and prevent bacterial adhesion to uroepithelia, but efficacy data for these treatments are sparse. The future of rUTI care rests in addressing the following contemporary issues: best diagnostic practices, risk factors associated with rUTI, and the prevention of recurrent infection. In this review, we summarize the state of the art for each of these issues and highlight future studies that will aim to take an alternative approach to managing rUTI.
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Affiliation(s)
- Anum Khan
- School of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Ravi Jhaveri
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine
| | - Patrick C Seed
- Ann and Robert H. Lurie Children’s Hospital and Stanley Manne Children’s Research Institute, Chicago, Illinois
| | - Mehreen Arshad
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
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Eswara JR, Castellan M, González R, Mendieta N, Cendron M. The urological management of children with spinal cord injury. World J Urol 2018; 36:1593-1601. [DOI: 10.1007/s00345-018-2433-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/02/2018] [Indexed: 11/28/2022] Open
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Tradewell M, Pariser JJ, Nimeh T, Elliott SP. Systematic review and practice policy statements on urinary tract infection prevention in adults with spina bifida. Transl Androl Urol 2018; 7:S205-S219. [PMID: 29928619 PMCID: PMC5989108 DOI: 10.21037/tau.2018.04.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/03/2022] Open
Abstract
Urinary tract infection (UTI) is a source of morbidity and healthcare costs in adults with spina bifida (ASB). UTI prevention strategies are often recommended, but the evidence of various approaches remains unclear. We performed a systematic review to inform a best practice policy statement for UTI prevention in ASB. On behalf of the Neurogenic Bladder Research Group (NBRG.org), we developed an a priori protocol and searched the published English literature for 30 outcomes questions addressing UTI prevention in ASB. The questions spanned the categories of antibiotics, oral supplements, bladder management factors and social support. Where there was little literature in ASB, we included literature from similar populations with neurogenic bladder (NB). Data was abstracted and then reviewed with recommendations made by consensus of all authors. Level of Evidence (LoE) and Grade of Recommendation (GoR) were according to the Oxford grading system. Of 6,433 articles identified by our search, we included 99 publications. There was sufficient evidence to support use of the following: saline bladder irrigation (LoE 1, GoR B), gentamicin bladder instillation (LoE 3, GoR C), single-use intermittent catheterization (IC) (LoE 2, GoR B), hydrophilic catheters for IC (LoE 2, GoR C), intradetrusor onabotulinumtoxinA injection (LoE 3, GoR C), hyaluronic acid (HA) instillation (LoE 1, GoR B), and care coordination (LoE 3, GoR C). There was sufficient evidence to recommend against use of the following: sterile IC (LoE 1, GoR B), oral antibiotic prophylaxis (LoE 2, GoR B), treatment of asymptomatic bacteriuria (LoE 2, GoR B), cranberry (LoE 2, GoR B), methenamine salts (LoE 1, GoR B), and ascorbic acid (LoE1, GoR B). There was insufficient evidence to make a recommendation for other outcomes. Overall, there are few studies in UTI prevention in the specific population of ASB. Research in populations similar to ASB helps to guide recommendations for UTI prevention in the challenging patient group of ASB. Future studies in UTI prevention specific to ASB are needed and should focus on areas shown to be of benefit in similar populations.
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Affiliation(s)
- Michael Tradewell
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Joseph J Pariser
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Tony Nimeh
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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Prieto J, Murphy CL, Moore KN, Fader M. WITHDRAWN: Intermittent catheterisation for long-term bladder management. Cochrane Database Syst Rev 2017; 8:CD006008. [PMID: 28796279 PMCID: PMC6483323 DOI: 10.1002/14651858.cd006008.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intermittent catheterisation is a commonly recommended procedure for people with incomplete bladder emptying. There are now several designs of intermittent catheter (e.g. different lengths, 'ready to use' presentation) with different materials (e.g. PVC-free) and coatings (e.g. hydrophilic). The most frequent complication of intermittent catheterisation is urinary tract infection (UTI), but satisfaction, preference and ease of use are also important to users. It is unclear which catheter designs, techniques or strategies affect the incidence of UTI, which are preferable to users and which are most cost effective. OBJECTIVES To compare one type of catheter design versus another, one type of catheter material versus another, aseptic catheterisation technique versus clean technique, single-use (sterile) catheters versus multiple-use (clean) catheters, self-catheterisation versus catheterisation by others and any other strategies designed to reduce UTI and other complications or improve user-reported outcomes (user satisfaction, preference, ease of use) and cost effectiveness in adults and children using intermittent catheterisation for incomplete bladder emptying. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 30 September 2013), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification. SELECTION CRITERIA Randomised controlled trials (RCTs) or randomised cross-over trials comparing at least two different catheter designs, catheterisation techniques or strategies. DATA COLLECTION AND ANALYSIS Two review authors assessed the methodological quality of trials and abstracted data. For dichotomous variables, risk ratios and 95% confidence intervals were derived for each outcome where possible. For continuous variables, mean differences and 95% confidence intervals were calculated for each outcome. Because of trial heterogeneity, it was not always possible to combine data to give an overall estimate of treatment effect. MAIN RESULTS Thirty-one trials met the inclusion criteria, including 13 RCTs and 18 cross-over trials. Most were small (less than 60 participants completed), although five trials had more than 100 participants. There was considerable variation in length of follow-up and definitions of UTI. Participant dropout was a problem for several trials, particularly where there was long-term follow-up to measure incidence of UTI. Fifteen trials were more than 10 years old and focused mainly on comparing different catheterisation techniques (e.g. single versus multiple-use) on clinical outcomes whereas, several more recent trials have focused on comparing different types of catheter designs or materials, especially coatings, and user preference. It was not possible to combine data from some trials owing to variations in the catheters tested and in particular the catheter coatings. Where there were data, confidence intervals around estimates were wide and hence clinically important differences in UTI and other outcomes could neither be identified nor reliably ruled out. No study assessed cost-effectiveness. AUTHORS' CONCLUSIONS Despite a total of 31 trials, there is still no convincing evidence that the incidence of UTI is affected by use of aseptic or clean technique, coated or uncoated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Results from user-reported outcomes varied. The current research evidence is weak and design issues are significant. More well-designed trials are strongly recommended. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheter designs, catheterisation techniques and strategies.
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Affiliation(s)
- Jacqui Prieto
- University of SouthamptonFaculty of Health SciencesRoom AA80, South Academic Block (Mailpoint11)Southampton General HospitalSouthamptonUKSO16 6YD
| | - Catherine L Murphy
- University of SouthamptonFaculty of Health SciencesRoom AA80, South Academic Block (Mailpoint11)Southampton General HospitalSouthamptonUKSO16 6YD
| | - Katherine N Moore
- University of AlbertaFaculty of Nursing3rd Floor, Clinical Sciences BuildingEdmontonCanadaT6G 2G7
| | - Mandy Fader
- University of SouthamptonFaculty of Health SciencesRoom AA80, South Academic Block (Mailpoint11)Southampton General HospitalSouthamptonUKSO16 6YD
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11
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Metcalfe PD. Neuropathic bladders: Investigation and treatment through their lifetime. Can Urol Assoc J 2017; 11:S81-S86. [PMID: 28265327 DOI: 10.5489/cuaj.4276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The child with a neuropathic bladder requires lifelong dedicated care. Just as each patient presents with unique physiology, each phase of their life presents varying challenges. The primary concern for our patients is their renal health, but continence and independence also play significant roles. Most patients can be managed conservatively, but a myriad of surgical options are also available, reinforcing our emphasis on individualized care. Appropriate pre-surgical planning is required to ensure the right patient receives the best operation for his/her wants and needs. Furthermore, the numerous potential complications must be understood and long-term followup and surveillance is required. This review outlines the basic pathophysiology, investigations, and treatments, with a focus on the changing needs throughout their lives.
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Affiliation(s)
- Peter D Metcalfe
- University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
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12
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Wragg R, Harris A, Patel M, Robb A, Chandran H, McCarthy L. Extended spectrum beta lactamase (ESBL) producing bacteria urinary tract infections and complex pediatric urology. J Pediatr Surg 2017; 52:286-288. [PMID: 27894763 DOI: 10.1016/j.jpedsurg.2016.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 11/08/2016] [Indexed: 11/18/2022]
Abstract
AIM OF THE STUDY Extended spectrum beta lactamase (ESBL) producing bacteria are resistant to most beta-lactam antibiotics including third-generation cephalosporins, quinolones and aminoglycosides. This resistance is plasmid-borne and can spread between species. Management of ESBL is challenging in children with recurrent urinary tract infections (UTIs) and complex urological abnormalities. We aim to quantify the risk in children and specifically in urological patients. METHODS Retrospective review of a microbiology database (April 2014 to November 2015). This identified urine isolates, pyuria, ESBL growth and patient demographics. Data analysis was by Chi square, Mann-Whitney U-test and ANOVA. A P value of <0.05 was taken as significant. MAIN RESULTS Analysis of 9418 urine samples showed 2619 with pure isolates, of which 1577 had pyuria (>10×106 WC/L). 136 urine cultures (n=79 patients) grew purely ESBL. Overall, 5.2% of urine isolates were ESBL and 9.5% isolates with pyuria (>100×106 WC/L) had ESBL, whereas only 22/1032 (2.1%) with no pyuria, (P<0.0001). Urology patients had 86/136 (63%) ESBL positive cultures. These represented 86/315 (27%) of all positive cultures for urology patients vs. 50/2267 (2.2%) for all other specialties (P<0.0001). Potential ESBL transmission between organisms occurred in 3 (all on prophylactic antibiotics). Over the study period, there was no significant rise of the monthly incidence between 2014 and 2015 (ANOVA P=0.1). CONCLUSION This study is the first to document the incidence of ESBL in children (5%), and estimate the frequency of possible plasmid transmission between bacterial species in children. This quantifies the risk of ESBL, especially to urology patients, and mandates better antibiotic stewardship. LEVEL OF EVIDENCE Level IIc.
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Affiliation(s)
- Ruth Wragg
- Department of Pediatric Urology, Birmingham Children's Hospital
| | - Anna Harris
- Department of Pediatric Urology, Birmingham Children's Hospital
| | - Mitul Patel
- Department of Microbiology, Birmingham Children's Hospital
| | - Andrew Robb
- Department of Pediatric Urology, Birmingham Children's Hospital
| | - Harish Chandran
- Department of Pediatric Urology, Birmingham Children's Hospital
| | - Liam McCarthy
- Department of Pediatric Urology, Birmingham Children's Hospital.
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Chaudhry R, Balsara ZR, Madden-Fuentes RJ, Wiener JS, Routh JC, Seed P, Ross SS. Risk Factors Associated With Recurrent Urinary Tract Infection in Neurogenic Bladders Managed by Clean Intermittent Catheterization. Urology 2017; 102:213-218. [PMID: 28065810 DOI: 10.1016/j.urology.2016.12.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 09/29/2016] [Accepted: 12/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify risk factors for recurrent urinary tract infection (UTI) in patients who perform clean intermittent catheterization (CIC). METHODS A 6-year retrospective chart review of patients with spina bifida or tethered cord who perform clean intermittent catheterization (8 months to 58 years) was conducted. A strict case definition for UTI was applied, and per-subject UTI events, demographic, and clinical data were abstracted. Data were compared between groups defined by no or infrequent UTI (≤1.0 UTI/study year) and frequent UTI (>1.0 UTI/study year). RESULTS Of 194 total patients, 146 (75%) had no UTIs or infrequent UTIs, and 48 (25%) patients had frequent UTIs. On univariate analysis, only younger age and suprasacral cord lesions were associated with frequent UTIs (P = .002 and P = .007, respectively). Among the 128 patients with urodynamic studies, bladder capacity, compliance, detrusor overactivity, and detrusor leak point pressure were not associated with frequent UTI on univariate analysis. On multivariate analysis, increasing age was found to be associated with decreased odds of UTI by 7% per year (odds ratio 0.93, P = .016). CONCLUSION The risk of UTI among individuals with spina bifida or tethered cord declines with increasing age. Bladder function based on urodynamic parameters did not correlate with frequent UTIs.
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Affiliation(s)
- Rajeev Chaudhry
- Department of Surgery, Division of Urologic Surgery, Duke University, Durham, NC
| | - Zarine R Balsara
- Department of Surgery, Division of Urologic Surgery, Duke University, Durham, NC
| | | | - John S Wiener
- Department of Surgery, Division of Urologic Surgery, Duke University, Durham, NC
| | - Jonathan C Routh
- Department of Surgery, Division of Urologic Surgery, Duke University, Durham, NC
| | - Patrick Seed
- Department of Pediatrics, Division of Infectious Disease, Duke University, Durham, NC
| | - Sherry S Ross
- Department of Urology, Section of Pediatric Urology, School of Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
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Biardeau X, Corcos J. Intermittent catheterization in neurologic patients: Update on genitourinary tract infection and urethral trauma. Ann Phys Rehabil Med 2016; 59:125-9. [DOI: 10.1016/j.rehab.2016.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 12/15/2022]
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Lee B, Featherstone N, Nagappan P, McCarthy L, O'Toole S. British Association of Paediatric Urologists consensus statement on the management of the neuropathic bladder. J Pediatr Urol 2016; 12:76-87. [PMID: 26946946 DOI: 10.1016/j.jpurol.2016.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/06/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A large number of children with spina bifida develop a neuropathic bladder and this group of patients still forms the largest group of children who require urological management. Although there are published guidelines on the management of the neuropathic bladder, they are not specific to children. It is unsurprising, therefore, that the initial investigation, assessment and management of children with spina bifida vary considerably. The 2014 British Association of Paediatric Urologists (BAPU) meeting was devoted to the management of the neuropathic bladder. The aim was to produce a consensus on the appropriate investigation and management of a child with a neuropathic bladder. METHODS AND MATERIALS A questionnaire was devised and the members were polled on their current practice. Six paediatric urology fellows presented an evidence-based literature review on different aspects of the neuropathic bladder. At the end of the session, the members of the organisation present were polled again using the same questions. RESULTS The BAPU felt that the use of urodynamics in the neuropathic bladder should be selectively determined by clinical parameters. Regarding CIC, the group was evenly split between universal use or only when poor emptying was established. Oxybutinin was the first-line anticholinergic of choice. Most paediatric urologists routinely used Botox and were happy to use it repeatedly. The surgical intervention most frequently employed was determined to be an ileocystoplasty, with most surgeons deferring the need for surveillance cystoscopy until at least 10 years after surgery. CONCLUSION It was felt that a consensus statement is not a guideline or a way to establish best practice; however, it serves as a way of surveying current practice and providing a benchmark for clinicians involved in the management of these patients.
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Affiliation(s)
- B Lee
- Department of Paediatric Surgery and Urology, Royal Hospital for Children, Glasgow, UK
| | - N Featherstone
- Department of Paediatric Surgery and Urology, Great Ormond Street Hospital for Sick Children, London, UK
| | - P Nagappan
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
| | - L McCarthy
- Department of Paediatric Urology, Birmingham Children's Hospital, Birmingham, UK
| | - S O'Toole
- Department of Paediatric Surgery and Urology, Royal Hospital for Children, Glasgow, UK. stuart.o'
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Lamin E, Newman DK. Clean intermittent catheterization revisited. Int Urol Nephrol 2016; 48:931-9. [DOI: 10.1007/s11255-016-1236-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/29/2016] [Indexed: 12/27/2022]
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AKİL İ, ÖZEN Ç, CENGİZ B. Do patients with neurogenic bladder treated with clean intermittentcatheterization need antibacterial prophylaxis? Turk J Med Sci 2016; 46:1151-4. [DOI: 10.3906/sag-1505-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/29/2015] [Indexed: 11/03/2022] Open
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Emergence of antimicrobial-resistant uropathogens isolated from pediatric patients with cystitis on daily clean intermittent catheterization. J Infect Chemother 2015. [DOI: 10.1016/j.jiac.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Brandström P, Hansson S. Long-term, low-dose prophylaxis against urinary tract infections in young children. Pediatr Nephrol 2015; 30:425-32. [PMID: 24906665 DOI: 10.1007/s00467-014-2854-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/01/2014] [Accepted: 05/09/2014] [Indexed: 11/25/2022]
Abstract
Urinary tract infection (UTI) affects about 2 % of boys and 8 % of girls during the first 6 years of life with Escherichia coli as the predominant pathogen. Symptomatic UTI causes discomfort and distress, and carries a risk of inducing renal damage. The strong correlation between febrile UTI, dilating vesicoureteral reflux (VUR), and renal scarring led to the introduction of antibiotic prophylaxis for children with VUR to reduce the rate of UTI recurrence. It became common practice to use prophylaxis for children with VUR and other urinary tract abnormalities. This policy has been challenged because of a lack of scientific support. Now, randomized controlled studies are available that compare prophylaxis to no treatment or placebo. They show that children with normal urinary tracts or non-dilating VUR do not benefit from prophylaxis. Dilating VUR may still be an indication for prophylaxis in young children. After the first year of life, boys have very few recurrences and do not benefit from prophylaxis. Girls with dilating VUR, on the other hand, are more prone to recurrences and benefit from prophylaxis. There has been a decline in the use of prophylaxis due to questioning of its efficacy, increasing bacterial resistance, and a propensity to low adherence to medication. Alternative measures to reduce UTI recurrences should be emphasized. However, in selected patients carefully followed, prophylaxis can protect from recurrent UTI and long-term sequelae. 1. There is a strong correlation between UTI, VUR, and renal scarring. 2. Children with normal urinary tracts or non-dilating VUR do not benefit from prophylaxis. 3. Young children, mainly girls, with dilating VUR are at risk of recurrent UTI and acquired renal scarring and seem to gain from antibiotic prophylaxis. 4. Increasing bacterial resistance and low adherence with prescribed medication is a major obstacle to successful antibiotic prophylaxis.
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Affiliation(s)
- Per Brandström
- Pediatric Uronephrologic Center, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Rondvägen 10, 416 85, Göteborg, Sweden
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Abstract
BACKGROUND Intermittent catheterisation is a commonly recommended procedure for people with incomplete bladder emptying. There are now several designs of intermittent catheter (e.g. different lengths, 'ready to use' presentation) with different materials (e.g. PVC-free) and coatings (e.g. hydrophilic). The most frequent complication of intermittent catheterisation is urinary tract infection (UTI), but satisfaction, preference and ease of use are also important to users. It is unclear which catheter designs, techniques or strategies affect the incidence of UTI, which are preferable to users and which are most cost effective. OBJECTIVES To compare one type of catheter design versus another, one type of catheter material versus another, aseptic catheterisation technique versus clean technique, single-use (sterile) catheters versus multiple-use (clean) catheters, self-catheterisation versus catheterisation by others and any other strategies designed to reduce UTI and other complications or improve user-reported outcomes (user satisfaction, preference, ease of use) and cost effectiveness in adults and children using intermittent catheterisation for incomplete bladder emptying. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 30 September 2013), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification. SELECTION CRITERIA Randomised controlled trials (RCTs) or randomised cross-over trials comparing at least two different catheter designs, catheterisation techniques or strategies. DATA COLLECTION AND ANALYSIS Two review authors assessed the methodological quality of trials and abstracted data. For dichotomous variables, risk ratios and 95% confidence intervals were derived for each outcome where possible. For continuous variables, mean differences and 95% confidence intervals were calculated for each outcome. Because of trial heterogeneity, it was not always possible to combine data to give an overall estimate of treatment effect. MAIN RESULTS Thirty-one trials met the inclusion criteria, including 13 RCTs and 18 cross-over trials. Most were small (less than 60 participants completed), although five trials had more than 100 participants. There was considerable variation in length of follow-up and definitions of UTI. Participant dropout was a problem for several trials, particularly where there was long-term follow-up to measure incidence of UTI. Fifteen trials were more than 10 years old and focused mainly on comparing different catheterisation techniques (e.g. single versus multiple-use) on clinical outcomes whereas, several more recent trials have focused on comparing different types of catheter designs or materials, especially coatings, and user preference. It was not possible to combine data from some trials owing to variations in the catheters tested and in particular the catheter coatings. Where there were data, confidence intervals around estimates were wide and hence clinically important differences in UTI and other outcomes could neither be identified nor reliably ruled out. No study assessed cost-effectiveness. AUTHORS' CONCLUSIONS Despite a total of 31 trials, there is still no convincing evidence that the incidence of UTI is affected by use of aseptic or clean technique, coated or uncoated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Results from user-reported outcomes varied. The current research evidence is weak and design issues are significant. More well-designed trials are strongly recommended. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheter designs, catheterisation techniques and strategies.
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Affiliation(s)
- Jacqui Prieto
- Faculty of Health Sciences, University of Southampton, Room AA80, South Academic Block (Mailpoint11), Southampton General Hospital, Southampton, UK, SO16 6YD
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Yıldız ZA, Candan C, Arga M, Turhan P, İşgüven P, Ergüven M. Urinary tract infections in children with myelodysplasia in whom clean intermittent catheterization was administered. Turk Arch Pediatr 2014; 49:36-41. [PMID: 26078630 DOI: 10.5152/tpa.2014.872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/22/2013] [Indexed: 11/22/2022]
Abstract
AIM In this study, it was aimed to evaluate the frequency of significant bacteriuria and antibiotic resistance characteristics in children with myelodysplasia in whom clean intermittent catheterization was administered. MATERIAL AND METHODS The study group was composed of 71 patients with myelodysplasia who were found to have significant bacteriuria (age: 8.20±4.57 years; 39 girls) and the control groups was composed of 49 children who were diagnosed with community-acquired urinary tract infection (age: 7.94±4.17 years; 29 girls). The patient and control groups were evaluated in terms of the microorganisms grown in urinary cultures and antibiotic resistance characteristics. The study approved by the ethics committe (14/02/2012-19/E). RESULTS Growth of Escherichia coli (E. coli) was found with the highest rate in myelodysplasic patients. However, when compared with the control group in terms of microorganism types, an increase in the growth rates of the microorganisms excluding E. coli was observed in the patients with myelodysplasia which was close to the significance limit (p=0.055). When antibiotic resistance properties were examined, a significantly increased resistance against cotrimaxazole was found in the patient group compared to the control group (p=0.001). 84.5% of the patients were using prophylactic antibiotic including mainly co-trimoxazole. A significantly increased co-trimoxazole resistance was also found in the patients who were using prophylactic antibiotic compared to the patients who were not using prophylactic antibiotic (p=0.025). The rate of symptomatic UTI was found to be 21% in the patients with myelodysplasia and a significant increase was found in the complaints of abdominal/side pain and nausea/vomiting as well as fever in these patients compared to the patients with asymptomatic bacteriuria (p=0.029 and p=0.032, respectively). CONCLUSION Our results show that UTI is still a significant problem in patients with myelodysplasia. In addition, they show that use of prophylactic antibiotic may increase the frequency of development of resistance and co-trimoxazole used for this objective is not a good option..
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Affiliation(s)
- Zuhal Albayrak Yıldız
- Department of Pediatrics, The Ministry of Health, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Cengiz Candan
- Unit of Pediatric Nephrology, The Ministry of Health, İstanbul Medeniyet University öztepe Education and Research Hospital, İstanbul, Turkey
| | - Mustafa Arga
- Department of Pediatrics, The Ministry of Health, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Pınar Turhan
- Unit of Pediatric Nephrology, The Ministry of Health, İstanbul Medeniyet University öztepe Education and Research Hospital, İstanbul, Turkey
| | - Pınar İşgüven
- Department of Pediatrics, The Ministry of Health, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Müferet Ergüven
- Department of Pediatrics, The Ministry of Health, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
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Adherence of Randomized Trials Within Children's Surgical Specialties Published During 2000 to 2009 to Standard Reporting Guidelines. J Am Coll Surg 2013; 217:394-399.e7. [DOI: 10.1016/j.jamcollsurg.2013.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/02/2013] [Accepted: 03/05/2013] [Indexed: 02/07/2023]
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Balsara ZR, Ross SS, Dolber PC, Wiener JS, Tang Y, Seed PC. Enhanced susceptibility to urinary tract infection in the spinal cord-injured host with neurogenic bladder. Infect Immun 2013; 81:3018-26. [PMID: 23753628 PMCID: PMC3719561 DOI: 10.1128/iai.00255-13] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 06/01/2013] [Indexed: 11/20/2022] Open
Abstract
Neurogenic bladder predisposes to recurrent urinary tract infections (UTI) and renal failure, and susceptibility is commonly ascribed to urinary stasis from elevated residual urine volumes. Escherichia coli UTI was modeled in the spinal cord-injured (SCI) rat with the hypothesis that SCI animals would require fewer bacteria to establish infection, have an exaggerated inflammatory response, and have delayed clearance of infection compared to normal-voiding controls. T10 SCI rats and controls had median infectious doses (ID50) of 10(2) and 10(5) CFU, respectively. Mean residual volumes in the SCI animals did not correlate with susceptibility to initiation of UTI or outcome. In the acute infection, control and SCI rats developed acute cystitis and pyelitis without acute differences in histopathological scores of inflammation. However, in vivo imaging of infected animals revealed persistently higher levels of bacteria in the SCI urine and bladders than were seen for controls over 2 weeks. Likewise, at 2 weeks, acute and chronic inflammatory infiltrates persisted in the bladders and kidneys of SCI rats, whereas inflammation largely resolved within the controls. Together these data demonstrate that SCI rats exhibit delayed clearance of infection and exaggerated inflammatory responses in bladders and kidneys; however, the severity of residual volumes does not predict increased susceptibility to UTI. These studies suggest that host-dependent mechanisms that are discrete from alterations in bladder physiology influence UTI susceptibility with the SCI-neurogenic bladder. This model will allow elucidation of SCI-neurogenic bladder-mediated changes in host response that yield UTI susceptibility and may lead to new preventative and therapeutic options.
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Affiliation(s)
- Zarine R. Balsara
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sherry S. Ross
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Paul C. Dolber
- Department of Surgery, Division of Surgical Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
- Research Services, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - John S. Wiener
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Yuping Tang
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Patrick C. Seed
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina, USA
- Center for Microbial Pathogenesis, Duke University Medical Center, Durham, North Carolina, USA
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Shen L, Zheng X, Zhang C, Zeng B, Hou C. Influence of different urination methods on the urinary systems of patients with spinal cord injury. J Int Med Res 2013. [PMID: 23206478 DOI: 10.1177/030006051204000536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study evaluated the influence of different urination methods on the urinary systems of patients with spinal cord injury. METHODS Patients with spinal cord injury were grouped according to their usual voiding method: clean intermittent catheterization (CIC); Credé manoeuvre/reflex voiding; indwelling catheterization; normal voiding. Urinary tract infections (UTIs) were monitored and type B-ultra-sonography (B-USG) scans, renal function tests and urodynamic studies were performed in all patients over a 2-year period. RESULTS Compared with the normal voiding group (n = 14), incidence rates of UTIs were significantly different in the Credé manoeuvre/reflex voiding (n = 26) and indwelling catheterization (n = 12) groups but not in the CIC group (n = 15). All intervention groups had a significantly higher rate of positive findings on B-USG scan and a significantly increased residual urine volume, compared with the normal voiding group. In addition, residual urine volume was significantly lower in the CIC group compared with the Credé manoeuvre/reflex voiding and indwelling catheterization groups. CONCLUSION CIC was shown to be the optimal method for assisted bladder voiding after spinal cord injury.
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Affiliation(s)
- L Shen
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
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Zegers BSHJ, Uiterwaal CCSPM, Verpoorten CC, Christiaens MMH, Kimpen JJLL, de Jong-de Vos van Steenwijk CCCE, van Gool JJD. Home screening for bacteriuria in children with spina bifida and clean intermittent catheterization. BMC Infect Dis 2012; 12:264. [PMID: 23082909 PMCID: PMC3507913 DOI: 10.1186/1471-2334-12-264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 10/17/2012] [Indexed: 11/20/2022] Open
Abstract
Background Significant bacteriuria (SBU) and urinary tract infections (UTIs) are common in patients with spina bifida and neuropathic detrusor sphincter dysfunction. Laboratory agar plated culture is the gold standard to establish SBU. It has the disadvantage of diagnostic and subsequent therapeutic delay. Leukocyte esterase tests (LETs) and dip slides proved to be useful in the general populations to exclude SBU and UTI. The aim of this study was to evaluate the reliability of LET and dip slide in children with spina bifida without symptoms of UTI. The reliability in children with asymptomatic SBU was not studied before. Methods In one hundred and twelve children with spina bifida on clean intermittent catheterization LETs and dip slides were compared with laboratory cultures. Both tests and agar plated cultures were performed on catheterized urine samples. The hypothesis was that the home tests are as accurate as laboratory cultures. Results A SBU was found in 45 (40%) of the 112 laboratory cultures. A negative LET excluded SBU (negative predictive value 96%), while a positive LET had a positive predictive value of 72%. The false positive rate was 28%. Dip slide determination of bacterial growth had no added value, other than serving as transport medium. Conclusions In spina bifida children, leukocyte esterase testing can be used to exclude significant bacteriuria at home, while dip slide tests have no added value to diagnose or exclude significant bacteriuria.
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Affiliation(s)
- Bas S H J Zegers
- Department of Pediatrics, Máxima Medical Center Veldhoven, The Netherlands.
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Niël-Weise BS, van den Broek PJ, da Silva EMK, Silva LA. Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev 2012:CD004201. [PMID: 22895939 DOI: 10.1002/14651858.cd004201.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND People requiring long-term bladder draining commonly experience catheter-associated urinary tract infection and other problems. OBJECTIVES To determine if certain catheter policies are better than others in terms of effectiveness, complications, quality of life and cost-effectiveness in long-term catheterised adults and children. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 September 2011). Additionally, we examined all reference lists of identified trials. SELECTION CRITERIA All randomised and quasi-randomised trials comparing catheter policies (route of insertion and use of antibiotics) for long-term (more than 14 days) catheterisation in adults and children. DATA COLLECTION AND ANALYSIS Data were extracted by two reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If the data in trials had not been fully reported, clarification was sought from the authors. When necessary, the incidence-density rates (IDR) and/or the incidence-density differences (IDD) within a certain time period were calculated. MAIN RESULTS Eight trials met the inclusion criteria involving 504 patients in four cross-over and four parallel-group randomised controlled trials. Only two of the pre-stated six comparisons were addressed in these trials. Four trials compared antibiotic prophylaxis with antibiotics when clinically indicated. For patients using intermittent catheterisation, there were inconsistent findings about the effect of antibiotic prophylaxis on symptomatic urinary tract infection (UTI). Only one study found a significant difference in the frequency of UTI favouring prophylaxis. For patients using indwelling urethral catheterisation, one small trial reported fewer episodes of symptomatic UTI in the prophylaxis group.Four trials compared antibiotic prophylaxis with giving antibiotics when microbiologically indicated. For patients using intermittent catheterisation, there was limited evidence that receiving antibiotics reduced the rate of bacteriuria (asymptomatic and symptomatic). There was weak evidence that prophylactic antibiotics were better in terms of fewer symptomatic bacteriuria. AUTHORS' CONCLUSIONS No eligible trials were identified that compared alternative routes of catheter insertion. The data from eight trials comparing different antibiotic policies were sparse, particularly when intermittent catheterisation was considered separately from indwelling catheterisation. Possible benefits of antibiotic prophylaxis must be balanced against possible adverse effects, such as development of antibiotic resistant bacteria. These cannot be reliably estimated from currently available trials.
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Mutlu H, Ekinci Z. Urinary tract infection prophylaxis in children with neurogenic bladder with cranberry capsules: randomized controlled trial. ISRN PEDIATRICS 2012; 2012:317280. [PMID: 22811926 PMCID: PMC3395198 DOI: 10.5402/2012/317280] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/10/2012] [Indexed: 06/01/2023]
Abstract
Objectives. The aim of this randomized controlled prospective study is to evaluate the efficacy of cranberry capsules for prevention of UTI in children with neurogenic bladder caused by myelomeningocele. Patients and Methods. To be eligible for this study, patients had to be diagnosed as neurogenic bladder caused by myelomeningocele, evaluated urodynamically, followed up with clean intermittent catheterization and anticholinergic drugs. Intervention. Six months of treatment with placebo; after a week of wash-out period treatment of cranberry extract tablets (1 capsule/day) for an additional 6 months. Randomization was performed sequentially. Patients and care givers were blinded to drug assignment. Main outcome measure was infection rate. Group comparisons were performed with Wilcoxon test. Results. The study population included 20 (F/M: 13/7) patients with neurogenic bladder with the mean age of 7.25 ± 3.49 (4, 18) years. The median UTI rate was 0.5/year during placebo usage whereas 0/year during cranberry capsule usage. Decrease in infection rate was significant with cranberry capsule usage (P = 0.012). Decrease in the percentage of the pyuria was also recorded as significant (P = 0.000). Any adverse events or side effects were not recorded. Conclusion. We concluded that cranberry capsules could be an encouraging option for the prevention of recurrent UTI in children with neurogenic bladder caused by myelomeningocele.
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Affiliation(s)
| | - Zelal Ekinci
- Department of Pediatric Nephrology, Kocaeli University Hospital, Umuttepe, 41380 Kocaeli, Turkey
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Zegers B, Uiterwaal C, Kimpen J, van Gool J, de Jong T, Winkler-Seinstra P, Houterman S, Verpoorten C, de Jong-de Vos van Steenwijk C. Antibiotic Prophylaxis for Urinary Tract Infections in Children With Spina Bifida on Intermittent Catheterization. J Urol 2011; 186:2365-70. [DOI: 10.1016/j.juro.2011.07.108] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Bas Zegers
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Department of Pediatrics, Maxima Medical Center, Veldhoven, The Netherlands
| | - Cuno Uiterwaal
- Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Jan Kimpen
- University Medical Center, Utrecht, The Netherlands
| | - Jan van Gool
- Division of Pediatric Urology, University Essen-Duisburg, Essen, Germany
| | - Tom de Jong
- University Medical Center, Utrecht, The Netherlands
| | | | | | - Carla Verpoorten
- Department of Pediatrics, Gasthuisberg University Hospital, Leuven, Belgium
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30
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Ostlie DJ, St Peter SD. The current state of evidence-based pediatric surgery. J Pediatr Surg 2010; 45:1940-6. [PMID: 20920710 DOI: 10.1016/j.jpedsurg.2010.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/03/2010] [Accepted: 05/06/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND The efficiency of medical care in the United States has become intensely scrutinized with expectations from patients, families, payors, lawmakers, and, currently, the President. The most effective vehicle to bring more efficient care is the employment of evidence-based medicine whenever possible. Evidence-based medicine is dependent on best evidence, and best evidence is generated from prospective trials. To evaluate current state of evidence based practice in pediatric surgery we reviewed the literature for trials conducted in our field the past 10 years. METHODS All randomized controlled trials from January 1999 through December 2009 published in the English literature were identified through a literature search using PubMed (www.pubmed.com). We included only those in pediatric general surgery excluding transplant, oncology, and the other nongeneral subspecialties. RESULTS The search criteria produced 56 manuscripts, of which 51 described appropriate randomization techniques. A definitive trial design with a sample size calculation was utilized in only 19 studies (34%). A statistically significant difference between treatment arms was identified in 29 of the 56 (52%) trials. There were 26 different journals of publication, with the Journal of Pediatric Surgery being most common (20) followed by Pediatric Surgery International (7). The combined total publications from January 1999 through December 2009 for the 26 journals these randomized trials represent 0.04% of all publications. Appendicitis was the most common condition that was studied (n = 10) followed by pyloric stenosis (n = 4). Trials originated in 19 different countries led by the United States (28%), United Kingdom (14%), and Turkey (12%). There was a generally progressive increase in published trials from 1999 to 2009, however, the percentage of prospective articles published in pediatric surgery was similar to a previous review published in 1999. CONCLUSIONS The current state of evidence-based surgery in pediatric surgery has remained stable in the first decade of the 21st century. Randomized controlled trials represent less than 0.05% of all publications involving pediatric surgery. Some of the hurdles to evidence based surgery are identified and reviewed.
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Affiliation(s)
- Daniel J Ostlie
- Center for Prospective Trials, Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, MO 64108, USA.
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31
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Farrugia MK, Malone PS. Educational article: The Mitrofanoff procedure. J Pediatr Urol 2010; 6:330-7. [PMID: 20188633 DOI: 10.1016/j.jpurol.2010.01.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Accepted: 01/26/2010] [Indexed: 11/24/2022]
Abstract
The management of urinary incontinence has been revolutionized by the introduction of intermittent catheterization by Lapides in 1972, and later, by the description of the 'trans-appendicular continent cystostomy' by Mitrofanoff in 1980. Mitrofanoff launched a new concept whereby the bladder could be emptied by a route other than the urethra. This concept led to the publication of a plethora of alternatives to the appendix conduit, including the transverse ileal (Yang-Monti) tube, and conduits constructed from ureter, Fallopian tube, tubularized preputial transverse island flap, and longitudinally tubularized ileal and gastric segments. Further experience with the procedure, and the onset of complications such as stomal stenosis and leakage, instigated the description of various stomal options and conduit implantation techniques. More recently, laparoscopic and robotically assisted techniques have also been performed. We present a review of these techniques, and the outcomes reported over the last 30 years since the Mitrofanoff principle was first described.
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Affiliation(s)
- Marie-Klaire Farrugia
- Department of Paediatric Urology, Southampton University Hospital NHS Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
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Sutkin G, Lowder JL, Smith KJ. Prophylactic antibiotics to prevent urinary tract infection during clean intermittent self-catheterization (CISC) for management of voiding dysfunction after prolapse and incontinence surgery: a decision analysis. Int Urogynecol J 2009; 20:933-8. [PMID: 19582384 DOI: 10.1007/s00192-009-0885-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 03/29/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study is to estimate efficacy of prophylactic antibiotics in UTI prevention during CISC for postoperative voiding dysfunction after prolapse/incontinence surgery. METHODS We constructed a decision tree model to evaluate risks and benefits of prophylactic antibiotics during CISC for voiding dysfunction after prolapse/incontinence surgery. The model randomized women requiring CISC to prophylactic antibiotics or no prophylaxis. Probabilities for UTI after CISC with or without prophylactic antibiotics, sequelae from antibiotic use or UTI, and utility values were obtained from published literature and practice quality assurance reviews. Main outcome was probability of experiencing no UTI or adverse event. RESULTS Under baseline assumptions, prophylactic antibiotics were favored in both models. In the true UTI model, prophylactic antibiotics had an 83.1% probability of no UTI or adverse events; 16.1% better than no prophylactic antibiotics. CONCLUSIONS Using decision analysis methods, prophylactic antibiotics are favored for prevention of UTI during CISC to manage voiding dysfunction after prolapse/incontinence surgery.
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Affiliation(s)
- Gary Sutkin
- Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh-School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
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33
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Zegers BSHJ, Winkler-Seinstra PLH, Uiterwaal CSPM, de Jong TVPM, Kimpen JLL, de Jong-de Vos van Steenwijk CCE. Urinary tract infections in children with spina bifida: an inventory of 41 European centers. Pediatr Nephrol 2009; 24:783-8. [PMID: 19066975 DOI: 10.1007/s00467-008-1067-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 11/07/2008] [Accepted: 11/10/2008] [Indexed: 11/28/2022]
Abstract
The introduction of clean intermittent catheterization (CIC) in 1972 and low-dose chemoprophylaxis (LDCP, antibiotic prophylaxis), anticholinergic medication and urological surgery in the mid-1980s has improved the long-term outcome of renal function in children with neurogenic bladder sphincter dysfunction (NBSD) due to spina bifida (SB). We have conducted a European survey of the protocols for diagnosing and treating urinary tract infections (UTIs) in these children, using a web-based questionnaire. The responses from 41 centers in 14 European countries confirm that although most centers have standardized protocols for treating UTIs, there is no consensus among European centers in terms of protocols for preventing, diagnosing and treating UTIs in children with NBSD and for CIC.
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Affiliation(s)
- Bas S H J Zegers
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Abstract
PURPOSE OF REVIEW Traditional management of vesicoureteral reflux focuses on preventing renal complications associated with ascending urinary tract infection by either providing continuous antibiotic prophylaxis to sterilize the urine and thus prevent recurrent infection, or abolishing reflux via surgical intervention. This review will consider the rationale for antibiotic prophylaxis in light of contemporary data regarding the natural history of vesicoureteral reflux, urinary tract infection and renal scarring, as well as the efficacy of various treatment strategies. RECENT FINDINGS Recent studies have shown that in grades I-IV vesicoureteral reflux, open surgical intervention compared with antibiotic prophylaxis is no better at preventing renal complications. Endoscopic subureteral injection of biomaterials has been proposed as a cost-effective, minimally invasive alternative to surgical or medical intervention; however, given the variety of materials and techniques, the literature has yet to achieve consensus on its efficacy. The first study to compare antibiotic prophylaxis with increased surveillance and prompt treatment of urinary tract infection shows no difference between the two approaches in low-grade (grades I-II) vesicoureteral reflux. SUMMARY Recent studies have challenged the traditional paradigm of aggressive vesicoureteral reflux management with surgery or antibiotic prophylaxis. In light of these findings, pediatric urologists will need to reexamine treatment modalities for vesicoureteral reflux.
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Affiliation(s)
- William C Faust
- Georgetown University School of Medicine, Washington, DC, USA
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36
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Frye MA. Pathophysiology, Diagnosis, and Management of Urinary Tract Infection in Horses. Vet Clin North Am Equine Pract 2006; 22:497-517, x. [PMID: 16882485 DOI: 10.1016/j.cveq.2006.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Equine urinary tract infection (UTI) most commonly occurs as a sequela to structural or functional inhibition of normal urine flow. Although it is an infrequent diagnosis in equids, the incidence of UTI in human beings is high and has inspired great investigative effort. The resultant findings with potentially broad application as well as current equine studies are reviewed here. Recent developments in the understanding of host-agent interactions and renal defense mechanisms, emerging antimicrobial resistance, and novel therapeutic alternatives to prophylactic antibiotic use are emphasized.
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Affiliation(s)
- Melinda A Frye
- Department of Clinical Sciences, Colorado State University Veterinary Medical Center, 300 West Drake, Fort Collins, CO 80526, USA.
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Schaeffer EM. Prophylactic use of antimicrobials in commonly performed outpatient urologic procedures. ACTA ACUST UNITED AC 2006; 3:24-31. [PMID: 16474491 DOI: 10.1038/ncpuro0357] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 09/28/2005] [Indexed: 11/08/2022]
Abstract
An antimicrobial is an agent capable of killing or inhibiting the growth of a micro-organism. Antimicrobial prophylaxis encompasses efforts to prevent postprocedure infections through the use of an antimicrobial agent before, and, in some cases, for a limited time after a procedure. A thorough history and physical examination are essential to identify host factors that increase a patient's risk for postprocedural infection. Risk-modifying factors include age, anatomy, geographical area of residence, immune and nutritional status, cardiac valve integrity, prosthetic joints, the presence of indwelling hardware and distant infectious wounds. Prophylaxis for the most common urologic outpatient procedures can be attained with oral trimethoprim-sulfamethoxazole or fluoroquinolone administered between 2 h and 30 min before a procedure. Special consideration for the type and duration of prophylaxis should be given to patients with moderate to severe cardiac valvular conditions and recently inserted prosthetic joints.
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Affiliation(s)
- Edward M Schaeffer
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD 21287-2101, USA.
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