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Pingree EW, Harper BD, Liu S, Neuman MI. National Trends in Voiding Cystourethrograms During Hospitalization for Young Infants With Urinary Tract Infections. Hosp Pediatr 2023; 13:904-911. [PMID: 37671444 DOI: 10.1542/hpeds.2022-007045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
OBJECTIVES The American Academy of Pediatrics published a guideline in 2011 recommending against the routine use of voiding cystourethrogram (VCUG) in infants aged 2 to 24 months with first febrile urinary tract infection (UTI); however, the rates of VCUG for infants aged <2 months are unknown. The objective of this study was to determine the trend in VCUG performance during index hospitalization among infants aged 0 to 2 months with UTI. METHODS This retrospective cohort study included infants aged birth to 2 months hospitalized with a UTI from 2008 to 2019 across 38 institutions in the Pediatric Health Information System. Outcome measures included recurrent UTI within 1 year, vesicoureteral reflux diagnosis within 1 year and antiurinary reflux procedure performed within 2 years. Trends over time were compared between preguideline (2008-2011) and postguideline periods (2012-2019) using piecewise mixed-effects logistic regression. RESULTS The odds of VCUG decreased by 21% per year in the preguideline period (adjusted odds ratio, 0.79; 95% confidence interval, 0.77-0.81; P < .001) versus 20% (adjusted odds ratio, 0.80; 95% confidence interval, 0.77-0.83; P < .001) in the postguideline period. The preguideline and postguideline difference was not statistically significant (P = .60). There was no difference in the postguideline odds of UTI within 1 year (P = .07), whereas the odds of vesicoureteral reflux diagnosis (P < .001) and antiurinary reflux procedure performance (P < .001) decreased. CONCLUSIONS VCUG performance during hospitalization has declined over the past decade among young infants hospitalized with UTI. Further work is needed to determine the optimal approach to imaging in these young infants.
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Affiliation(s)
| | | | - Shanshan Liu
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
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AlMatrafi B, Al Otay A, Alhelaly A, Alhagbani M, Alquliti A. Clinical Outcomes of Voiding Cystourethrogram and Antibiotic Prophylaxis. Cureus 2023; 15:e46814. [PMID: 37954724 PMCID: PMC10636231 DOI: 10.7759/cureus.46814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Background Urinary tract infections (UTIs) are a prevalent and potentially serious bacterial infection observed among children. Presently, the primary use of diagnostic imaging for UTI is to pinpoint young patients who are at a high risk of developing renal scarring. The most significant procedure for pediatric urology fluoroscopic evaluation is voiding cystourethrogram (VCUG). VCUG-acquired UTIs continue to be an important concern and the purpose of this study is to assess the clinical outcomes of antibiotic prophylaxis on VCUG-associated UTIs. Methods This retrospective study included all patients who underwent VCUG procedures performed from the year 2014 to 2021. All data were retrieved from the medical registries and databases. Radiological and laboratory investigations related to the VCUG procedures were thoroughly reviewed. Patients were considered to have post-procedure UTI if urological symptoms including fever and dysuria along with positive urine culture were exhibited within four weeks after the VCUG study. Patients with incomplete medical records were excluded from the analysis. Results This study consisted of 147 participants. Continuous antibiotic prophylaxis (CAP) was observed in 57 (38.8%) participants of them 35 (23.8%) participants suffered from UTI while urine culture and sensitivity testing were performed among 142 (96.6%) participants before VCUG which came negative and only five (3.4%) had a positive result. Overall, the results of the Chi-square test of association revealed a significant association between sex and vesicoureteral reflux (VUR), indicating that the prevalence of VUR differs between males and females. However, no significant associations were observed between VUR and UTI, urine culture and sensitivity results, hydronephrosis, type of catheter, or choice of antibiotic. Conclusion In conclusion, this study contributes valuable insights into the clinical outcomes of antibiotic prophylaxis on VCUG-associated UTIs. Despite the prophylaxis rate of 38.8%, UTIs were still observed in a significant proportion of children undergoing VCUG. This calls for further research to identify additional risk factors, optimize prophylaxis strategies, and enhance the overall safety and efficacy of VCUG procedures in children.
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Affiliation(s)
- Bassam AlMatrafi
- Department of Pediatric Surgery, Maternity and Children Hospital, Makkah, SAU
| | | | - Ahmed Alhelaly
- Department of Urology, Prince Sultan Military Medical City, Riyadh, SAU
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Ngweso S, Nyandoro M, Nzenza T, Cheow TY, Bettenay F, Barker A, Khosa J, Samnakay N. Culture-positive urinary tract infection following micturating cystourethrogram in children. Asian J Urol 2022; 9:329-333. [PMID: 36035343 PMCID: PMC9399525 DOI: 10.1016/j.ajur.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To determine the incidence of culture-positive urinary tract infection (UTI) after micturating cystourethrogram (MCUG). We further wanted to identify risk factors for developing a culture-positive UTI following MCUG. Methods A retrospective review of the available medical records of 500 paediatric patients who underwent MCUG in Perth, Western Australia was performed. Results Seven (1.4%) patients comprised of four females and three males developed a febrile, culture-positive UTI within 14 days following MCUG. Significant association was found for female patients, patients with neurogenic bladder, and patients with previous culture-positive UTI as developing a culture-positive UTI following MCUG. Multivariate logistic regression determined that patients were more likely to develop culture-positive UTI within 14 days following MCUG if they had a known history of UTI (odds ratio: 5.0, 95% confidence interval: 1.5–17.3, p=0.010) or had a neurogenic bladder (odds ratio: 4.2, 95% confidence interval: 1.0–17.9, p=0.049). Conclusion The incidence of patients who developed a febrile, culture-positive UTI following MCUG was low at 1.4%. Statistically significant and independent associations for the development of culture positive UTI were found in patients with neurogenic bladder and patients with previous culture-positive UTI. Further prospective studies are necessary to determine necessity of prophylactic antibiotics for high-risk patients, e.g., patients with neurogenic bladder or previous culture-positive UTI.
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Affiliation(s)
- Simeon Ngweso
- Fiona Stanley Hospital. Murdoch, Western Australia, Australia.,Young Urology Researchers Organisation, Melbourne, Australia
| | | | - Tatenda Nzenza
- Young Urology Researchers Organisation, Melbourne, Australia.,Austin Hospital, Heidelberg, Victoria, Australia
| | - Ting Yi Cheow
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Fiona Bettenay
- Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Andrew Barker
- Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Japinder Khosa
- Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Naeem Samnakay
- Princess Margaret Hospital, Subiaco, Western Australia, Australia.,School of Medicine, University of Western Australia, Dalkeith, Western Australia, Australia
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't Hoen LA, Bogaert G, Radmayr C, Dogan HS, Nijman RJM, Quaedackers J, Rawashdeh YF, Silay MS, Tekgul S, Bhatt NR, Stein R. Update of the EAU/ESPU guidelines on urinary tract infections in children. J Pediatr Urol 2021; 17:200-207. [PMID: 33589366 DOI: 10.1016/j.jpurol.2021.01.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION/BACKGROUND Urinary tract infections (UTIs) are common in children and require appropriate diagnostic evaluation, management and follow-up. OBJECTIVE To provide a summary of the updated European Association of Urology (EAU) guidelines on Pediatric Urology, which were first published in 2015 in European Urology. STUDY DESIGN A structured literature review was performed of new publications between 2015 and 2020 for UTIs in children. The guideline was updated accordingly with relevant new literature. RESULTS The occurrence of a UTI can be the first indication of anatomical abnormalities in the urinary tract, especially in patients with a febrile UTI. The basic diagnostic evaluation should include sufficient investigations to exclude urinary tract abnormalities, but should also be as minimally invasive as possible. In recent years, more risk factors have been identified to predict the presence of these anatomical anomalies, such as a non-E. Coli infection, high grade fever and ultrasound abnormalities. When these risk factors are factored into the diagnostic work-up, some invasive investigations can be omitted in a larger group of children. In addition to the treatment of active UTIs, it is also essential to prevent recurrent UTIs and consequent renal scarring. With the increase of antimicrobial resistance good antibiotic stewardship is needed. In addition, alternative preventative measures such as dietary supplements, bladder and bowel management and antibiotic prophylaxis could decrease the incidence of recurrent UTI. CONCLUSION This paper is a summary of the updated 2021 EAU guidelines on Pediatric Urology. It provides practical considerations and flowcharts for the management and diagnostic evaluation of UTIs in children.
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Affiliation(s)
- Lisette A 't Hoen
- Department of Pediatric Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hasan S Dogan
- Division of Pediatric Urology, Hacettepe University, Ankara, Turkey
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Center Groningen, Rijks University Groningen, Groningen, the Netherlands
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Center Groningen, Rijks University Groningen, Groningen, the Netherlands
| | | | - Mesrur S Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Biruni University, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Hacettepe University, Ankara, Turkey
| | - Nikita R Bhatt
- Department of Urology, East of England Deanery, Urology, Cambridge, United Kingdom
| | - Raimund Stein
- Center for Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Mazzi S, Rohner K, Hayes W, Weitz M. Timing of voiding cystourethrography after febrile urinary tract infection in children: a systematic review. Arch Dis Child 2020; 105:264-269. [PMID: 31466991 DOI: 10.1136/archdischild-2019-316958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite a trend towards early voiding cystourethrography (VCUG) after febrile urinary tract infection (fUTI) in children, clinical guidelines do not comment on the optimal timing and current practice varies considerably. OBJECTIVE To assess whether the detection rate of vesicoureteric reflux (VUR) in children depends on the time period of VCUG procedure after onset of antibiotic therapy. METHODS MEDLINE, EMBASE and Cochrane Controlled Trials Register electronic databases were searched for eligible studies without language or time restriction (19 November 2018). Inclusion criteria were (1) patients <18 years of age; (2) VCUG performed in patients with fUTI after onset of antibiotic therapy either in the same patient population or in two or more different patient populations within one study at different time periods; and (3) with reported detection rate of VUR. The systematic review was carried out following the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS Of 4175 records, nine studies were included (number of patients, n=1745) for the main outcome prevalence of VUR by VCUG <8 days compared with VCUG ≥8 days after onset of antibiotic therapy. Pooled overall prevalence of VUR was not significantly different between the early and the late VCUG groups (risk ratio 0.98, 95% CI 0.81 to 1.19). Prevalence of VUR stratified by grade was not significantly different between the two groups. CONCLUSION Early VCUG within 8 days after onset of antibiotic therapy does not affect the prevalence of VUR. TRIAL REGISTRATION NUMBER CRD42018117545.
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Affiliation(s)
- Sara Mazzi
- Paediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Katharina Rohner
- Pediatric Nephrology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Wesley Hayes
- Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK.,University College London Centre for Nephrology, London, UK
| | - Marcus Weitz
- Nephrology, University Children's Hospital Zurich, Zurich, Switzerland
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Toward a Framework for Benefit-Risk Assessment in Diagnostic Imaging: Identifying Scenario-specific Criteria. Acad Radiol 2017; 24:538-549. [PMID: 28372958 DOI: 10.1016/j.acra.2017.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES Diagnostic imaging has many effects and there is no common definition of value in diagnostic radiology. As benefit-risk trade-offs are rarely made explicit, it is not clear which framework is used in clinical guideline development. We describe initial steps toward the creation of a benefit-risk framework for diagnostic radiology. MATERIALS AND METHODS We performed a literature search and an online survey of physicians to identify and collect benefit-risk criteria (BRC) relevant to diagnostic imaging tests. We operationalized a process for selection of BRC with the use of four clinical use case scenarios that vary by diagnostic alternatives and clinical indication. Respondent BRC selections were compared across clinical scenarios and between radiologists and nonradiologists. RESULTS Thirty-six BRC were identified and organized into three domains: (1) those that account for differences attributable only to the test or device (n = 17); (2) those that account for clinical management and provider experiences (n = 12); and (3) those that capture patient experience (n = 7). Forty-eight survey participants selected 22 criteria from the initial list in the survey (9-11 per case). Engaging ordering physicians increased the number of criteria selected in each of the four clinical scenarios presented. We developed a process for standardizing selection of BRC in guideline development. CONCLUSION These results suggest that a process relying on elements of comparative effectiveness and the use of standardized BRC may ensure consistent examination of differences among alternatives by way of making explicit implicit trade-offs that otherwise enter the decision-making space and detract from consistency and transparency. These findings also highlight the need for multidisciplinary teams that include input from ordering physicians.
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Zieger B. [Imaging in urinary tract infections in childhood]. Radiologe 2016; 56:997-1012. [PMID: 27770147 DOI: 10.1007/s00117-016-0133-7] [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] [Indexed: 10/20/2022]
Abstract
Diagnostic strategies for extended morphological and functional clarification after symptomatic urinary tract infections in children are changing. Improved knowledge of the causes for development of renal scarring and a changing view on the importance of vesicoureteral reflux have led to a change in paradigm in recent years. The purpose of this article is to present the ongoing discussions of the causes and outcome of childhood urinary tract infections, competing diagnostic imaging methods and different diagnostic algorithms.
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Affiliation(s)
- B Zieger
- Abteilung für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstraße 11, 78050, Villingen‑Schwenningen, Deutschland.
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Yousefichaijan P, Dorreh F, Shahsavari S, Pakniyat A. Comparing between results and complications of doing voiding cystourethrogram in the first week following urinary tract infection and in 2-6 weeks after urinary tract infection in children referring to a teaching hospital. J Renal Inj Prev 2016; 5:144-7. [PMID: 27689111 PMCID: PMC5040001 DOI: 10.15171/jrip.2016.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/05/2016] [Indexed: 12/01/2022] Open
Abstract
Introduction: Urinary tract infection is the most common genitourinary disease in children so about 40% of the children with urinary tract infection suffering from reflux that caused some consequences such as pyelonephritis and kidney parenchymal injury.
Objectives: This research was conducted to compare the timing of voiding cystourethrogram (VCUG) in children with urinary tract infection in first week and after the first week of urinary tract infection.
Patients and Methods: This research is a case-control study that both case and control groups include 208 children from 1 month to 12 years old with the complain of urinary tract infection. In case group, the VCUG was performed at the first week of infection and in control group, the VCUG was performed after the first week of infection.
Results: complication such as dysuria was observed in two-thirds of children who VCUG was performed during first week after urinary tract infection. Parents stress in case group was more than the other (P=0.015). For overall, the incidence of reflux in case and control groups was 49.5% and 50%, respectively. The mean of reflux grading in right kidney in case group was lower than control group resulting in significant differences between two groups.
Conclusion: According to higher grade of stress in parents and complications due to VCUG at the first week of urinary tract infection, it is suggested that VCUG be conducted on selective patients in the hospital at the first week of urinary tract infection and during hospitalization.
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Affiliation(s)
- Parsa Yousefichaijan
- Amirkabir Hospital, Department of Pediatric, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Fatemeh Dorreh
- Amirkabir Hospital, Department of Pediatric, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Someyeh Shahsavari
- Amirkabir Hospital, Department of Pediatric, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Abdolghader Pakniyat
- Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran
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Stein R, Dogan HS, Hoebeke P, Kočvara R, Nijman RJM, Radmayr C, Tekgül S. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2014; 67:546-58. [PMID: 25477258 DOI: 10.1016/j.eururo.2014.11.007] [Citation(s) in RCA: 217] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 11/05/2014] [Indexed: 12/22/2022]
Abstract
CONTEXT In 30% of children with urinary tract anomalies, urinary tract infection (UTI) can be the first sign. Failure to identify patients at risk can result in damage to the upper urinary tract. OBJECTIVE To provide recommendations for the diagnosis, treatment, and imaging of children presenting with UTI. EVIDENCE ACQUISITION The recommendations were developed after a review of the literature and a search of PubMed and Embase. A consensus decision was adopted when evidence was low. EVIDENCE SYNTHESIS UTIs are classified according to site, episode, symptoms, and complicating factors. For acute treatment, site and severity are the most important. Urine sampling by suprapubic aspiration or catheterisation has a low contamination rate and confirms UTI. Using a plastic bag to collect urine, a UTI can only be excluded if the dipstick is negative for both leukocyte esterase and nitrite or microscopic analysis is negative for both pyuria and bacteriuria. A clean voided midstream urine sample after cleaning the external genitalia has good diagnostic accuracy in toilet-trained children. In children with febrile UTI, antibiotic treatment should be initiated as soon as possible to eradicate infection, prevent bacteraemia, improve outcome, and reduce the likelihood of renal involvement. Ultrasound of the urinary tract is advised to exclude obstructive uropathy. Depending on sex, age, and clinical presentation, vesicoureteral reflux should be excluded. Antibacterial prophylaxis is beneficial. In toilet-trained children, bladder and bowel dysfunction needs to be excluded. CONCLUSIONS The level of evidence is high for the diagnosis of UTI and treatment in children but not for imaging to identify patients at risk for upper urinary tract damage. PATIENT SUMMARY In these guidelines, we looked at the diagnosis, treatment, and imaging of children with urinary tract infection. There are strong recommendations on diagnosis and treatment; we also advise exclusion of obstructive uropathy within 24h and later vesicoureteral reflux, if indicated.
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Affiliation(s)
- Raimund Stein
- Division of Paediatric Urology, Department of Urology, Mainz University Medical Centre, Johannes Gutenberg University, Mainz, Germany.
| | - Hasan S Dogan
- Hacettepe University, Faculty of Medicine, Department of Urology, Division of Paediatric Urology, Ankara, Turkey
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Radim Kočvara
- Department of Urology, General Teaching Hospital in Praha, and Charles University 1st Faculty of Medicine, Praha, Czech Republic
| | - Rien J M Nijman
- Department of Urology, Division of Pediatric Urology, University of Groningen, Groningen, The Netherlands
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Serdar Tekgül
- Hacettepe University, Faculty of Medicine, Department of Urology, Division of Paediatric Urology, Ankara, Turkey
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