MP54-09 ANTIMICROBIAL EXPOSURE AND UROPATHOGEN RESISTANCE: AN ANALYSIS OF INDIVIDUAL PATIENT DATA FROM RCTS ON ANTIBIOTIC PROPHYLAXIS AND THE PREVENTION OF UTI

Abstract

bacteriuria at the time of urologic surgery may put patients at risk for complications. Many providers obtain preoperative and/or intraoperative urine cultures when performing surgery on the urinary tract, but there are no data in the literature documenting the overall rate of positive urine culture at the time of pediatric urologic surgery. We hypothesized that there are risk factors associated with an increased likelihood of positive urine culture at the time of pediatric urologic surgery. METHODS: We identified all patients less than 18 years of age undergoing endoscopic urologic procedure or surgery on the collecting system from 01/01/08 through 12/31/13 with a single pediatric urologist (JBC) who routinely sends intraoperative urine cultures. We performed a retrospective chart review, collecting demographic information, intraoperative urine culture results (defined as positive if >100,000 or 10100,000 CFU of a single pathogenic organism), circumcision status, and suspected risk factors from problem/diagnosis lists (hydronephrosis, vesicoureteral reflux, UPJ obstruction, urolithiasis, neurogenic bladder, posterior urethral valves, ureterocele, and constipation). We also examined all prior urine culture results in our electronic medical record. We then analyzed each item for relative risk of positive urine culture at the time of surgery. RESULTS: A total of 838 procedure records (470 unique patients) were reviewed. 717 had associated intraoperative urine culture results (85.6%) and were further analyzed. Overall, 97 (13.5%) cultures were positive. Factors associated with increased relative risk included neurogenic bladder (p<0.0001), prior UTI (p<0.0001), constipation (p<0.0001), female gender, (p1⁄40.001), and urolithiasis (p<0.05). The absence of any of the selected diagnoses was associated with a reduced risk of positive culture (p<0.05). CONCLUSIONS: Patients with neurogenic bladder, prior UTI, constipation, female gender, and urolithiasis have an increased likelihood of bacteriuria at the time of pediatric urologic surgery. This information may be helpful in tailoring the acquisition of preoperative and/or intraoperative urine cultures, which may result in significant cost savings.