MP55-17 URINARY TRACT INFECTION AFTER RETROGRADE URETHROGRAM IN CHILDREN: A MULTICENTER STUDY

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2016MP55-17 URINARY TRACT INFECTION AFTER RETROGRADE URETHROGRAM IN CHILDREN: A MULTICENTER STUDY Neha Malhotra, Jared Green, Cynthia Rigsby, Jane Holl, Earl Cheng, and Emilie Johnson Neha MalhotraNeha Malhotra More articles by this author , Jared GreenJared Green More articles by this author , Cynthia RigsbyCynthia Rigsby More articles by this author , Jane HollJane Holl More articles by this author , Earl ChengEarl Cheng More articles by this author , and Emilie JohnsonEmilie Johnson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.608AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radiologic procedures such as retrograde urethrogram (RUG) and voiding cystourethrogram (VCUG) requiring catheterization and retrograde instillation of contrast carry an inherent risk of post-procedural urinary tract infection (ppUTI). However, the risk of ppUTI after RUG has not been well quantified. Prophylactic antibiotics may reduce the risk, but this benefit must be weighed against the risk of inducing antibiotic resistance. Our aims were to (1) describe the rate of ppUTI after RUG, and (2) examine the factors associated with use of antibiotics before, and ppUTI after, RUG. METHODS We conducted a retrospective cohort study of children <18 years old undergoing RUG at 2 pediatric hospitals from 1/04-12/14. We excluded studies with concurrent VCUG and children with no follow-up. Descriptive statistics were used for demographic and clinical characteristics. ppUTI within 7 days of RUG was measured. Antibiotic prophylaxis was determined and relationships between clinical characteristics and receipt of pre-procedure antibiotics were evaluated using Fisher exact testing. RESULTS 43 patients (98% male, median age 11.7 years) underwent 48 RUGs. The most common indications were trauma (27%), hypospadias (17%), and non-hypospadias (27%) stricture. Three patients (7%) had a history of posterior urethral valves (PUV), 1 had a neurogenic bladder (NGB); 27% had prior urethral surgery. 52% of RUGs revealed no abnormalities; the most common abnormality was stricture (31%). Two (4%) studies were performed within 30 days of a clinical UTI and 10% of children had a positive urinalysis or culture within 30 days pre-RUG. Clinical UTI in the prior 30 days was not significantly associated with pre-RUG antibiotic use (1/29 patients on antibiotics (3%); 1/19 patients not on antibiotics (5%) had a pre-RUG UTI, p = 1.0). Only 1 (2.1%; 95% CI 0 – 6.2%) child had a ppUTI. This was a 7 year-old uncircumcised male with a history of PUV, strictures and voiding dysfunction. He was asymptomatic, had a negative pre-RUG urine culture, and was not on antibiotics. RUG revealed a bulbar stricture. Seven days later, the child had a febrile E. coli UTI requiring admission. CONCLUSIONS The risk of ppUTI after RUG is very low (2.1% in our study, maximum 6.2%). We were unable to evaluate for specific predictors of ppUTI due to the low incidence. Use of antibiotics was unrelated pre-RUG UTI. Given the low incidence of ppUTI, this study suggests that routine prophylaxis with antibiotics prior to RUG is not indicated. Prophylaxis for select patients (i.e. PUV or NGB) may be warranted. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e743 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Neha Malhotra More articles by this author Jared Green More articles by this author Cynthia Rigsby More articles by this author Jane Holl More articles by this author Earl Cheng More articles by this author Emilie Johnson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...