Occurrence of Urinary Tract Infection in Children With Significant Upper Urinary Tract Obstruction

Abstract

Ureteropelvic junction obstruction and obstructive megaureter are common causes of upper urinary tract obstruction. Recent data have demonstrated that the rate of urinary tract infection (UTI) among children with upper tract obstruction not treated with prophylactic antibiotics is >36%. The aim of this study was to evaluate the occurrence of UTI in our patients with ureteropelvic junction obstruction and megaureter to better assess the role of prophylactic antibiotics. A retrospective analysis was conducted. The inclusion criteria were grade 3 or 4 hydronephrosis secondary to obstructive megaureter or ureteropelvic junction obstruction in children not maintained on prophylactic antibiotics. UTI was defined as a culture-documented symptomatic infection. Fisher's exact tests were used to evaluate for an association between the occurrence of UTI with sex, level of obstruction, grade of hydronephrosis, and circumcision status. A total of 92 patients met the study criteria. The rate of UTI in all patients was 4.3% (95% confidence interval 0.2%-8.6%). No statistically significant difference in the infection rate was noted according to sex, obstruction level, hydronephrosis grade, or circumcision status. Our results have demonstrated a low occurrence of UTI in antenatally diagnosed patients not maintained on antibiotics. We have concluded that antibiotic prophylaxis is unlikely to benefit most children with grade 3 or 4 hydronephrosis secondary to upper tract obstruction.