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Doval L, Paye-Jaouen A, Pierucci UM, Lachkar AA, Duneton C, Lopez P, Tanase A, Alison M, El-Ghoneimi A, Peycelon M. Incidence of febrile post-procedural urinary tract infection following voiding cystourethrography in children without prior urine culture. World J Urol 2024; 42:499. [PMID: 39215768 DOI: 10.1007/s00345-024-05217-5] [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: 06/25/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE Post-procedural urinary tract infections (ppUTIs) following voiding cystourethrography (VCUG) vary widely, with rates from 0 to 42%, though recent studies suggest rates typically below 5%. Verifying urine sterility before VCUG is traditionally done but questioned. This study assessed the 7-day ppUTI rate post-VCUG without prior urine sterility confirmation and identified associated risk factors. METHODS A retrospective review of VCUG cases in children under three years at a pediatric hospital over two years was conducted. Exclusions included neuropathic bladder, bladder exstrophy, pre-VCUG urine cultures, and lost-to-follow-up cases. Achieving a ppUTI rate below 5% would support safe VCUG practice without pre-urine culture. RESULTS Of 318 VCUGs performed on 300 children, 248 (78%) were males (8% circumcised) with a median age of 5 months. Retrograde VCUG was more common than suprapubic cystography (63% vs. 37%). Before the test, 33.6% received antibiotics, mostly prophylactically. Hydronephrosis was present in 66.4%, and 69% had a history of UTI. VCUG results were abnormal in 43% of cases: 85% had vesicoureteral reflux (VUR), 10% had posterior urethral valves (PUV), and 28% had other abnormalities. The 7-day ppUTI rate was 3.8%, with 67% of ppUTI cases having abnormal VCUG results versus 41% without ppUTI (p = 0.06). No significant risk factors for ppUTI were identified. CONCLUSIONS Omitting systematic urine culture before VCUG was not associated with a high ppUTI rate, even in children with pre-existing urologic conditions or a history of UTI, indicating that VCUG can be safely performed without prior urine sterility confirmation. No risk factors for ppUTI were identified.
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Affiliation(s)
- Lauren Doval
- Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN Accredited Center, Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, 48, Boulevard Sérurier, 75019, Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN Accredited Center, Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, 48, Boulevard Sérurier, 75019, Paris, France
| | - Ugo Maria Pierucci
- Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN Accredited Center, Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, 48, Boulevard Sérurier, 75019, Paris, France
- Department of Pediatric Surgery, Buzzi Children's Hospital, 20154, Milan, Italy
| | - Amane-Allah Lachkar
- Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN Accredited Center, Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, 48, Boulevard Sérurier, 75019, Paris, France
| | - Charlotte Duneton
- Department of Pediatric Nephrology, National Reference Center for Rare Urinary Tract Malformations (MARVU), Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, Paris, France
| | - Pauline Lopez
- Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN Accredited Center, Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, 48, Boulevard Sérurier, 75019, Paris, France
| | - Anca Tanase
- Department of Pediatric and Prenatal Imaging, National Reference Center for Rare Urinary Tract Malformations (MARVU), Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, Inserm U1141, NeuroDiderot, Paris, France
| | - Marianne Alison
- Department of Pediatric and Prenatal Imaging, National Reference Center for Rare Urinary Tract Malformations (MARVU), Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, Inserm U1141, NeuroDiderot, Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN Accredited Center, Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, 48, Boulevard Sérurier, 75019, Paris, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN Accredited Center, Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, 48, Boulevard Sérurier, 75019, Paris, France.
- UMR INSERM 1141 NEURODEV, Paris, France.
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van der Steeg HJJ, Luijten JCHBM, Fascetti-Leon F, Miserez M, Samuk I, Stenström P, de Wall LL, de Blaauw I, van Rooij IALM. High-grade Vesicoureteral Reflux in Patients With Anorectal Malformation From the ARM-Net Registry: Is Our Screening Sufficient? J Pediatr Surg 2024; 59:1470-1476. [PMID: 38355337 DOI: 10.1016/j.jpedsurg.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/24/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Vesico-ureteral reflux (VUR) is a common associated urological anomaly in anorectal malformation (ARM)-patients. High-grade VUR requires antibiotic prophylaxis to prevent urinary tract infections (UTI's), renal scarring and -failure. The exact prevalence of high-grade VUR in ARM patients is unknown. Hence, the aim of this study was determining the incidence of high-grade VUR in ARM-patients, and its associated risk factors. METHODS A multicenter retrospective cohort study was performed using the ARM-Net registry, including data from 34 centers. Patient characteristics, screening for and presence of renal anomalies and VUR, sacral and spinal anomalies, and sacral ratio were registered. Phenotypes of ARM were grouped according to their complexity in complex and less complex. Multivariable analyses were performed to detect independent risk factors for high-grade (grade III-V) VUR. RESULTS This study included 2502 patients (50 % female). Renal screening was performed in 2250 patients (90 %), of whom 648 (29 %) had a renal anomaly documented. VUR-screening was performed in 789 patients (32 %), establishing high-grade VUR in 150 (19 %). In patients with a normal renal screening, high-grade VUR was still present in 10 % of patients. Independent risk factors for presence of high-grade VUR were a complex ARM (OR 2.6, 95 %CI 1.6-4.3), and any renal anomaly (OR 3.3, 95 %CI 2.1-5.3). CONCLUSIONS Although renal screening is performed in the vast majority of patients, only 32 % underwent VUR-screening. Complex ARM and any renal anomaly were independent risk factors for high-grade VUR. Remarkably, 10 % had high-grade VUR despite normal renal screening. Therefore, VUR-screening seems indicated in all ARM patients regardless of renal screening results, to prevent sequelae such as UTI's, renal scarring and ultimately renal failure. TYPE OF STUDY Observational Cohort-Study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- H J J van der Steeg
- Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands.
| | - J C H B M Luijten
- Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - F Fascetti-Leon
- Department of Pediatric Surgery, University of Padua, Padua, Italy
| | - M Miserez
- Department of Abdominal Surgery, UZ Leuven, KU Leuven, Belgium
| | - I Samuk
- Department of Pediatric Surgery, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Stenström
- Department of Pediatrics, Clinical Sciences Lund University, Skane University Hospital Lund, Sweden
| | - L L de Wall
- Department of Urology, Division of Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - I de Blaauw
- Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - I A L M van Rooij
- Department for Health Evidence, Radboud University Medical Center Nijmegen, the Netherlands
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Preka E, Miller N, Avramescu M, Berteloot L, Vinit N, Botto N, Grapin M, Prévot M, Boistault M, Garcelon N, Taghavi K, Schrimpf C, Cohen JF, Blanc T, Boyer O. Vesico-ureteral reflux diagnosis after initial kidney abscess: Results from a Paediatric Tertiary Hospital. Acta Paediatr 2024. [PMID: 38967007 DOI: 10.1111/apa.17353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
AIMS Guidelines regarding voiding cystourethrogram (VCUG) indications following a paediatric kidney abscess are lacking. This study evaluates vesicoureteral reflux (VUR) prevalence and outcome after a first kidney abscess. METHODS This retrospective study included all children presenting to a tertiary paediatric reference centre with de-novo kidney abscesses from 2011 to 2022, diagnosed through imaging (ultrasonography or computed tomography). VCUG's clinical utility was assessed by exploring outcomes related to interventions. RESULTS Among the 17 patients (median age 9 months, IQR; 6 months-6 years), VCUG identified VUR in 7 (41%; 95% CI: 18-65%), including two with grade IV-V. Median abscess size was 19 mm (IQR; 14-27). 7/8 (88%) children with DMSA scan presented scars, including 4 with hypofunctioning (20%-44%), and one with a non-functioning kidney. Scarring on the DMSA scan was similar regardless of identified VUR. Six children had subsequent pyelonephritis. Three of the remaining 11 had grade I-III and two IV-V VUR. Surgery was required in four children overall: three for recurrent pyelonephritis and one for high-grade VUR and scars. CONCLUSION Among initial kidney abscess cases, 41% had VUR, similar to children experiencing their first uncomplicated pyelonephritis. VCUG results guided antibiotic prophylaxis but not surgical decisions. We suggest considering VCUG following recurrent pyelonephritis/kidney abscess and/or kidney scarring.
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Affiliation(s)
- Evgenia Preka
- Université Paris Cité, INSERM U970, PARCC, Paris Translational Research Centre for Organ, Transplantation, Paris, France
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | | | - Marina Avramescu
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Laureline Berteloot
- Imagerie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, APHP, Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Nicolas Vinit
- Chirurgie et Urologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
| | - Nathalie Botto
- Chirurgie et Urologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
| | - Mathilde Grapin
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Maud Prévot
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Margaux Boistault
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Nicolas Garcelon
- Data Science Platform, Imagine Institute, INSERM U1163, Université Paris Cité, Paris, France
| | - Kiarash Taghavi
- Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Cécile Schrimpf
- Urgences Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Jérémie F Cohen
- Pédiatre Générale et Maladies Infectieuses Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
| | - Thomas Blanc
- Chirurgie et Urologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
| | - Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
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Santos AI, Ferreira RT. Nuclear medicine and pediatric nephro-urology: a long-lasting successful partnership. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2024; 68:3-22. [PMID: 38445832 DOI: 10.23736/s1824-4785.24.03557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Congenital anomalies of the kidney and urinary tract, as well as urinary infections, are very frequent in children. After the clinical and laboratory evaluation, the first imaging procedure to be done is a renal and bladder ultrasound, but afterwards, a main contribution comes from nuclear medicine. Through minimally invasive and sedation-free procedures, nuclear medicine allows the evaluation of the functional anatomy of the urinary tract, and the quantification of renal function and drainage. If pediatric dosage cards provided by scientific societies are used, radiation exposure can also be low. In the pediatric conditions previously mentioned, nuclear medicine is used both for initial diagnosis and follow-up, mostly in cases of suspicion of ureteropelvic or ureterovesical junction syndromes, as well as vesicoureteral reflux or renal scars of febrile infectious episodes. Pediatric nephro-urology constitutes a significant workload of pediatric nuclear medicine departments. The following paragraphs are a revision of the renal radiopharmaceuticals, as well as the nuclear nephro-urology procedures - dynamic and static renal scintigraphy, and direct and indirect radionuclide cystography. A summary of the techniques, main indications, interpretation criteria and pitfalls will be provided. Some future directions for the field are also pointed out, among which the most relevant is the need for nuclear medicine professionals to use standardized protocols and integrate multidisciplinary teams with other pediatric and adult health professionals that manage these life-long pediatric pathologies, which are recognized as an important cause of adult chronic kidney disease.
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Affiliation(s)
- Ana I Santos
- Service of Nuclear Medicine, Hospital Garcia de Orta, Almada, Portugal -
- Nova Medical School, NOVA University, Lisbon, Portugal -
| | - Rita T Ferreira
- Service of Nuclear Medicine, Hospital Garcia de Orta, Almada, Portugal
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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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Shannon R, Meyer T, Saldano DD, Beilke L, Snow-Lisy DC, Patel SJ, Rosoklija I, Johnson EK, Yerkes EB. Prospective evaluation of a pediatric urodynamics protocol before and after limiting urine cultures. J Pediatr Urol 2022; 19:194.e1-194.e8. [PMID: 36628829 DOI: 10.1016/j.jpurol.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE While our institution has historically obtained a urine culture (UCx) from every child at the time of urodynamics (UDS), no consensus exists on UDS UCx utility, and practice varies widely. This study aims to prospectively study our symptomatic post-UDS UTI rate before and after implementing a targeted UCx protocol. MATERIALS AND METHODS A 2-part prospective study of patients undergoing UDS at one pediatric hospital was undertaken, divided into Phase 1 (7/2016-6/2017) with routine UCx at the time of UDS and Phase 2 (7/2019-6/2020) after implementation of a protocol limiting UCx at the time of UDS to only a targeted subset of patients. The primary outcome was symptomatic post-UDS UTI, defined as positive UCx ≥10ˆ4 CFU/mL and fever ≥38.5 °C or new urinary symptoms within seven days of UDS. RESULTS A total of 1,154 UDS were included: 553 in 483 unique patients during Phase 1 and 601 in 533 unique patients during Phase 2. Age, sex, race, ethnicity, and bladder management did not differ significantly between phases. All 553 UDS in Phase 1 had UCx at the time of UDS, compared to 34% (204/601) in Phase 2. The rate of positive UCx decreased from 39% in Phase 1-35% in Phase 2. Three patients developed symptomatic post-UDS UTI in each study period, resulting in a stable post-UDS UTI rate of 0.5% (3/553) in Phase 1 and 0.5% (3/601) in Phase 2. These patients varied in age, sex, UDS indication, and bladder management. Four of the six (67%) patients had positive UCx at the time of UDS, one had a negative UCx, and one had no UCx under the targeted UCx protocol. Predictors of symptomatic post-UDS UTI could not be evaluated. DISCUSSION In the largest prospective study to date, we found that symptomatic post-UDS UTI was <1% and that UCx at the time of UDS can safely be limited at our hospital. This reduction has important implications for cost containment and antibiotic stewardship. We will continue iterative modifications to our protocol, which may eventually include the elimination of UCx at the time of UDS in all groups. CONCLUSIONS This 2-part prospective evaluation at one pediatric hospital determined that the symptomatic post-UDS UTI rate remained <1% with no identifiable predictors after limiting previously universal UCx at the time of UDS to only a targeted subset of patients.
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Affiliation(s)
- Rachel Shannon
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA.
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA.
| | - Dawn Diaz Saldano
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA.
| | - Liza Beilke
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA.
| | - Devon C Snow-Lisy
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA.
| | - Sameer J Patel
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, USA.
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA.
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA; Department of Urology, Northwestern University Feinberg School of Medicine, USA.
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, USA; Department of Urology, Northwestern University Feinberg School of Medicine, USA.
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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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Thanneeru SK, Ravindra AS, Toms AS, Jacob TJ, Kurian JJ. Incidence of post-procedure symptomatic urinary tract infection in children undergoing micturition cystourethrogram in the absence of antibiotic cover. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [DOI: 10.1186/s43054-022-00106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Context
Prophylactic antibiotics are usually not recommended for an in and out catheterization. However procedures involving similar catheterizations like micturition cystourethrogram (MCUG) and cystometrogram are being performed under prophylactic antibiotic cover.
Aims
We aim to find the incidence of symptomatic urinary tract infections following MCUG done in children without antibiotic cover.
Settings and design
A retrospective cross sectional study was conducted on 398 patients who underwent MCUG from January 2015 to January 2016. The median age was 24 months and here were 272 males and 126 females, with 102 of them being infants.
Methods and material
Urine microscopy or culture was checked before performing the MCUG and only those without UTI were included in the study. Those with symptomatic and culture proven UTI within 2 weeks post-MCUG were defined as having post-procedure UTI (ppUTI). The incidence of post-procedure UTI was calculated and was compared with other studies.
Statistical analysis used
Data was entered in Microsoft Excel and analyzed using SPSS. Categorical variables were summarized as percentage and continuous variables were summarized as mean with standard deviation.
Results
Symptomatic procedure induced UTI were seen in only 3 of the 398 (0.75%) patients with a 95% CI of 0.02–0.008.
Conclusions
Strict adherence to aseptic precautions while performing an MCUG and prompt initiation of appropriate therapy when indicated may help obviate the need for routine administration of pre procedure antibiotics before MCUG.
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Antimicrobial Prophylaxis for Urologic Procedures in Paediatric Patients: A RAND/UCLA Appropriateness Method Consensus Study in Italy. Antibiotics (Basel) 2022; 11:antibiotics11030296. [PMID: 35326760 PMCID: PMC8944721 DOI: 10.3390/antibiotics11030296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 02/05/2023] Open
Abstract
The main aim of surgical antimicrobial prophylaxis (SAP) in urologic procedures is to prevent bacteraemia, surgical site infections (SSIs), and postoperative urinary tract infections (ppUTIs). Guidelines for SAP in paediatric urology are lacking. Only some aspects of this complex topic have been studied, and the use of antibiotic prophylaxis prior to surgical procedures seems to be more often linked to institutional schools of thought or experts’ opinions than to rules dictated by studies demonstrating the most correct and preferred management. Therefore, the aim of this Consensus document realized using the RAND/UCLA appropriateness method is to provide clinicians with a series of recommendations on SAP for the prevention of bacteraemia, SSIs, and ppUTIs after urologic imaging and surgical procedures in paediatric patients. Despite the few available studies, experts agree on some basilar concepts related to SAP for urologic procedures in paediatric patients. Before any urological procedure is conducted, UTI must be excluded. Clean procedures do not require SAP, with the exception of prosthetic device implantation and groin and perineal incisions where the SSI risk may be increased. In contrast, SAP is needed in clean-contaminated procedures. Studies have also suggested the safety of eliminating SAP in paediatric hernia repair and orchiopexy. To limit the emergence of resistance, every effort to reduce and rationalize antibiotic consumption for SAP must be made. Increased use of antibiotic stewardship can be greatly effective in this regard.
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Middleton T, Zarifa I, Jancauskaite M, Subramanian T, MacDonald C. Letter to the Editor in response to: Routine evaluation of vesicle-ureteric reflux in children with ano-rectal malformation does not reduce the rate of urinary tract infection. J Pediatr Surg 2022; 57:326. [PMID: 34389156 DOI: 10.1016/j.jpedsurg.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Thomas Middleton
- Sheffield Children's Hospital, Paediatric Surgical Department, PSU Department, Steveonson Wing, Western Bank, Sheffield, S10 2TH, UK.
| | - Iyad Zarifa
- Sheffield Children's Hospital, Paediatric Surgical Department, Sheffield, UK
| | - Milda Jancauskaite
- Sheffield Children's Hospital, Paediatric Surgical Department, Sheffield, UK
| | | | - Caroline MacDonald
- Sheffield Children's Hospital, Paediatric Surgical Department, Sheffield, UK
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Eroglu Y, Yildirim K, Çinar A, Yildirim M. Diagnosis and grading of vesicoureteral reflux on voiding cystourethrography images in children using a deep hybrid model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 210:106369. [PMID: 34474195 DOI: 10.1016/j.cmpb.2021.106369] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Vesicoureteral reflux is the leakage of urine from the bladder into the ureter. As a result, urinary tract infections and kidney scarring can occur in children. Voiding cystourethrography is the primary radiological imaging method used to diagnose vesicoureteral reflux in children with a history of recurrent urinary tract infection. Besides the diagnosis of reflux, it is graded with voiding cystourethrography. In this study, we aimed to diagnose and grade vesicoureteral reflux in Voiding cystourethrography images using hybrid CNN in deep learning methods. METHODS Images of pediatric patients diagnosed with VUR between 2016 and 2021 in our hospital (Firat University Hospital) were graded according to the international vesicoureteral reflux radiographic grading system. VCUG images of 236 normal and 992 with vesicoureteral reflux pediatric patients were available. A total of 6 classes were created as normal and graded 1-5 patients. RESULTS In this study, a hybrid-based mRMR (Minimum Redundancy Maximum Relevance) using CNN (Convolutional Neural Networks) model is developed for the diagnosis and grading of vesicoureteral reflux on voiding cystourethrography images. Googlenet, MobilenetV2, and Densenet201 models are used as a part of the hybrid architecture. The obtained features from these architectures are examined in concatenating process. Then, these features are classified in machine learning classifiers after optimizing with the mRMR method. Among the models used in the study, the highest accuracy value was obtained in the proposed model with an accuracy rate of 96.9%. CONCLUSIONS It shows that the hybrid model developed according to the findings of our study can be used in the diagnosis and grading of vesicoureteral reflux in voiding cystourethrography images.
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Affiliation(s)
- Yesim Eroglu
- Department of Radiology, Firat University School of Medicine, Elazig, Turkey.
| | - Kadir Yildirim
- Department of Urology, Turgut Ozal University, Malatya, Turkey.
| | - Ahmet Çinar
- Department of Computer Engineering, Firat University, Elazig, Turkey.
| | - Muhammed Yildirim
- Department of Computer Engineering, Firat University, Elazig, Turkey.
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Martins JS, Pinto M, Braga M, Calhau P. INCIDENCE OF URINARY TRACT INFECTION AFTER CYSTOGRAPHY. REVISTA PAULISTA DE PEDIATRIA 2020; 39:e2019386. [PMID: 33237135 PMCID: PMC7681943 DOI: 10.1590/1984-0462/2021/39/2019386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/03/2020] [Indexed: 11/26/2022]
Abstract
Objective: Cystography an invasive procedure with potential complications such as
urinary infection (UI). There are few studies about the incidence of
complications associated with this procedure. The purpose of this study is
to evaluate the incidence of post-cystography urinary infection (UI.). Methods: Retrospective study with a review of clinical records of patients under 15
years of age, followed in this hospital, who underwent cystography
(radiologic or indirect radionuclide) between 2009 and 2018.
Post-cystography UI was defined when it occurred until seven days after the
procedure. Descriptive and nonparametric statistics were applied to assess
possible predictive factors related with post-cystography UI. Results: In the study period, 531 cystograms were undertaken (55% indirect
radionuclide and 45% radiologic). The mean age at the procedure was 11.5
months; 62% were boys. Every patient had a previous negative urine culture;
50% were under antibiotic prophylaxis at the time of the procedure. The most
common indication for the procedure was the post-natal study of congenital
hydronephrosis/other nephrological malformation (53%), followed by the study
of febrile UI (31%). Vesicoureteral reflux (VUR) was diagnosed in 40% of
procedures. Post-cystography UI occurred in 23 cases (incidence of 4.3%).
The most frequent microorganism was E. coli (52%). The
presence of VUR was significantly associated with the occurrence of
post-cystography IU. Conclusions: The incidence of post-cystography UI was low in our sample. The presence of
VUR was significantly associated with the occurrence of post-cystography UI.
The authors highlight the importance of an adequate catheterization
technique and the need for clinical surveillance after the procedure.
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Affiliation(s)
| | - Margarida Pinto
- Pediatric Service at Hospital Garcia de Orta, E.P.E., Almada, Portugal
| | - Manuela Braga
- Pediatric Service at Hospital Garcia de Orta, E.P.E., Almada, Portugal
| | - Paulo Calhau
- Pediatric Service at Hospital Garcia de Orta, E.P.E., Almada, Portugal
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14
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Pediatric Urodynamic Study Without a Preprocedural Urine Culture, Is It Safe in Clinical Practice? Urology 2020; 145:224-228. [DOI: 10.1016/j.urology.2020.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022]
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15
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Ammenti A, Alberici I, Brugnara M, Chimenz R, Guarino S, La Manna A, La Scola C, Maringhini S, Marra G, Materassi M, Morello W, Nicolini G, Pennesi M, Pisanello L, Pugliese F, Scozzola F, Sica F, Toffolo A, Montini G. Updated Italian recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children. Acta Paediatr 2020; 109:236-247. [PMID: 31454101 PMCID: PMC7004047 DOI: 10.1111/apa.14988] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022]
Abstract
AIM Our aim was to update the recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children, which were endorsed in 2012 by the Italian Society of Pediatric Nephrology. METHODS The Italian recommendations were revised on the basis of a review of the literature published from 2012 to October 2018. We also carried out an ad hoc evaluation of the risk factors to identify children with high-grade vesicoureteral reflux or renal scarring, which were published in the previous recommendations. When evidence was not available, the working group held extensive discussions, during various meetings and through email exchanges. RESULTS Four major modifications have been introduced. The method for collecting urine for culture and its interpretation has been re-evaluated. We have reformulated the algorithm that guides clinical decisions to proceed with voiding cystourethrography. The suggested antibiotics have been revised, and we have recommended further restrictions of the use of antibiotic prophylaxis. CONCLUSION These updated recommendations have now been endorsed by the Italian Society of Pediatric Nephrology and the Italian Society for Pediatric Infectivology. They can also be used to compare other recommendations that are available, as a worldwide consensus in this area is still lacking.
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Affiliation(s)
- Anita Ammenti
- Pediatric Polyspecialistic GroupPoliambulatorio Medi‐SaluserParmaItaly
| | - Irene Alberici
- Department of Woman and Child's HealthUniversity of PadovaPadovaItaly
| | | | - Roberto Chimenz
- Pediatric Nephrology and Dialysis UnitDepartment of PediatricsG. Martino HospitalUniversity of MessinaMessinaItaly
| | - Stefano Guarino
- Department of WomanChild and of General and Specialized SurgeryUniversità degli Studi della Campania L. VanvitelliNaplesItaly
| | - Angela La Manna
- Department of WomanChild and of General and Specialized SurgeryUniversità degli Studi della Campania L. VanvitelliNaplesItaly
| | - Claudio La Scola
- Nephrology and Dialysis UnitDepartment of PediatricsAzienda Ospedaliero Universitaria Sant'Orsola‐MalpighiBolognaItaly
| | | | - Giuseppina Marra
- Pediatric NephrologyDialysis and Transplant UnitFondazione Ca'Granda, IRCCS Policlinico di MilanoMilanoItaly
| | | | - William Morello
- Pediatric NephrologyDialysis and Transplant UnitFondazione Ca'Granda, IRCCS Policlinico di MilanoMilanoItaly
| | | | - Marco Pennesi
- Department of PediatricsInstitute for Child and Maternal HealthIRCCS Burlo GarofoloTriesteItaly
| | | | | | | | | | | | - Giovanni Montini
- Pediatric NephrologyDialysis and Transplant UnitFondazione Ca'Granda, IRCCS Policlinico di MilanoMilanoItaly
- Giuliana and Bernardo Caprotti Chair of PediatricsDepartment of Clinical Sciences and Community HealthUniversity of MilanoMilanoItaly
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Marzuillo P, Guarino S, Esposito T, Campana G, Stanco M, Rambaldi PF, Miraglia Del Giudice E, La Manna A. Antibiotics for urethral catheterization in children undergoing cystography: retrospective evaluation of a single-center cohort of pediatric non-toilet-trained patients. Eur J Pediatr 2019; 178:423-425. [PMID: 30506395 DOI: 10.1007/s00431-018-3288-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
Antibiotics are often used to prevent post-catheterization urinary tract infections (UTIs) in patients undergoing cystography. However, there is no universally accepted protocol and the literature data are conflicting. We aimed to determine prevalence and risk factors of post-cystography UTIs in non-toilet-trained children. We retrospectively evaluated 216 non-toilet-trained children not assuming antibiotics when undergoing cystography. Only the patients with dilated vesico-ureteral reflux (VUR) assumed antibiotics just after the exam (within 15 min). One hundred eleven patients without vesico-ureteral reflux (VUR) and 29 patients with non-dilated VUR did not receive post-procedure antibiotics and did not develop UTIs. Out of the 76 patients who showed a dilated VUR and received post-procedure antibiotics, only 5 (6.6%) developed a UTI. The most significant factor associated with post-cystography UTIs was the presence of dilated VUR (p = 0.005) with the presence of bilateral VUR also being significant (p = 0.02).Conclusion: Patients without dilated VUR or bilateral VUR could not benefit from antibiotic prophylaxis for cystography. What is Known: • There is no universally accepted protocol about antibiotic administration in children undergoing cystography. • Literature data are conflicting. What is New: • Among 216 non-toilet-trained children undergoing cystography, 111 patients without vesico-ureteral reflux (VUR) and 29 patients with non-dilated VUR did not receive post-procedure antibiotics and did not develop UTIs. Out of the 76 patients who showed a dilated VUR and received post-procedure antibiotics, only 5 (6.6%) developed a UTI. • The most significant factor associated to post-cystography UTIs was the presence of dilated VUR (p = 0.005) with presence of bilateral VUR also being significant (p = 0.02).
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Affiliation(s)
- Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
| | - Tiziana Esposito
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Giuseppina Campana
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Michela Stanco
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Pier Francesco Rambaldi
- Department of Radiological Sciences, Nuclear Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Angela La Manna
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
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Leung AK, Wong AH, Leung AA, Hon KL. Urinary Tract Infection in Children. RECENT PATENTS ON INFLAMMATION & ALLERGY DRUG DISCOVERY 2019; 13:2-18. [PMID: 30592257 PMCID: PMC6751349 DOI: 10.2174/1872213x13666181228154940] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urinary Tract Infection (UTI) is a common infection in children. Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition. OBJECTIVE To provide an update on the evaluation, diagnosis, and treatment of urinary tract infection in children. METHODS A PubMed search was completed in clinical queries using the key terms "urinary tract infection", "pyelonephritis" OR "cystitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature and the pediatric age group. Patents were searched using the key terms "urinary tract infection" "pyelonephritis" OR "cystitis" from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com. RESULTS Escherichia coli accounts for 80 to 90% of UTI in children. The symptoms and signs are nonspecific throughout infancy. Unexplained fever is the most common symptom of UTI during the first two years of life. After the second year of life, symptoms and signs of pyelonephritis include fever, chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include suprapubic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children to radiation. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcome. The choice of antibiotics should take into consideration local data on antibiotic resistance patterns. Recent patents related to the management of UTI are discussed. CONCLUSION Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI. Parenteral antibiotic therapy is recommended for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication. A combination of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin can be used in those situations. Routine antimicrobial prophylaxis is rarely justified, but continuous antimicrobial prophylaxis should be considered for children with frequent febrile UTI.
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Affiliation(s)
- Alexander K.C. Leung
- Address correspondence to this author at the Department of Pediatrics, the University of Calgary, Alberta Children’s Hospital, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada; Tel: (403) 230 3300; Fax: (403) 230 3322; E-mail:
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18
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Johnin K, Kobayashi K, Tsuru T, Yoshida T, Kageyama S, Kawauchi A. Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children. Int J Urol 2018; 26:160-171. [PMID: 30569659 DOI: 10.1111/iju.13881] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 12/24/2022]
Abstract
Voiding cystourethrography is the most important fluoroscopic examination in pediatric urology for the investigation of lower urogenital tract diseases, such as vesicoureteral reflux or urethral stricture. However, this invasive procedure imposes a significant burden on children and their parents, and recently there has been a paradigm shift in the diagnosis and treatment of vesicoureteral reflux. In the 2011 revision, the American Academy of Pediatrics guidelines on urinary tract infection recommended abandoning routine voiding cystourethrography after the first febrile urinary tract infection. In 2014, the randomized intervention for children with vesicoureteral reflux study recommended discontinuation of routine continuous antibiotic prophylaxis for vesicoureteral reflux. The time is now ripe to radically reconsider indications for voiding cystourethrography and the procedure itself.
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Affiliation(s)
- Kazuyoshi Johnin
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kenichi Kobayashi
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Teruhiko Tsuru
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tetsuya Yoshida
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Susumu Kageyama
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akihiro Kawauchi
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
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19
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Varda BK, Finkelstein JB, Wang HH, Logvinenko T, Nelson CP. The association between continuous antibiotic prophylaxis and UTI from birth until initial postnatal imaging evaluation among newborns with antenatal hydronephrosis. J Pediatr Urol 2018; 14:539.e1-539.e6. [PMID: 29891187 PMCID: PMC6265114 DOI: 10.1016/j.jpurol.2018.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/15/2018] [Indexed: 10/16/2022]
Abstract
INTRODUCTION There is a lack of consensus regarding the use of continuous antibiotic prophylaxis (CAP) during the interval between birth and initial postnatal imaging in infants with a history of antenatal urinary tract dilation (AUTD). OBJECTIVE To determine the incidence of urinary tract infection (UTI), and the association between CAP use and UTI during the interval between birth and the first postnatal renal ultrasound (RUS) in infants with AUTD. STUDY DESIGN A single-institution, retrospective cohort study of newborns with a history of AUTD. Infants undergoing RUS within 3 months of birth for an indication of 'hydronephrosis' between 2012 and 2014 were identified. A random sample of 500 infants was selected; six were excluded for concomitant congenital anomalies. Baseline patient (sex, race, insurance) and clinical characteristics (circumcision status, UTD risk score, receipt of CAP, UTI prior to RUS, age at UTI, and age at RUS) were collected via retrospective chart review. Descriptive statistics were calculated. To adjust for receipt of CAP, propensity score adjusted univariate logistic regression for UTI based on CAP status was performed. RESULTS Among the 494 infants with AUTD, 157 (32%) received CAP. Infants with normal/low-risk UTD scores were less likely to receive CAP than those with medium/high-risk UTD (23% vs 77%; P < 0.001). There was no difference in CAP based on sex, insurance, or circumcision status (among 260/365 males with known circumcision status). Overall, seven infants (1.4%) developed UTI prior to imaging: six (1.8%) without CAP vs one (0.64%) with CAP (P = 0.44). The median age at UTI was 59 days (range 2-84); among those with UTI, initial imaging occurred significantly later (66 vs 28 days; P = 0.001). The propensity score adjusted odds of developing UTI with CAP (vs without) was 0.93 (95% CI 0.10-8.32; P = 0.95). The Summary Figure describes the infants with UTI. CONCLUSION The incidence of UTI prior to initial neonatal imaging in newborns with AUTD was low. Use of CAP was not associated with UTI incidence after adjusting for UTD severity. Routine use of CAP in newborns with AUTD prior to initial imaging may be of limited benefit in most patients.
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Affiliation(s)
- B K Varda
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
| | - J B Finkelstein
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - H-H Wang
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - T Logvinenko
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - C P Nelson
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
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