Incidence Of Febrile Urinary Tract Infection Research Articles

Transitional Outcomes of Adults Who Underwent Cohen Ureteroneocystostomy for the Treatment of Vesicoureteral Reflux as Children.

To analyze the transitional outcomes of children who underwent Cohen ureteroneocystostomy(UNC) due to vesicoureteral reflux(VUR). Files of patients who underwent UNC between January 2003 and December 2013 and had>10 years of follow-up were retrospectively reviewed. Demographic and clinical data before surgery were noted. Lower urinary tract dysfunction (LUTD) status was assessed via ICIQ M/F-LUTS, voiding diary and uroflowmetry in all patients. Renal functions, hypertension, proteinuria, febrile/afebrile urinary tract infections(UTIs), and complications associated with pregnancy were noted. Two hundred and forty-one patients (140 girls, 58.1%) underwent UNC at a median age of 6.5 years (3-14), and 57.7% underwent bilateral surgery. After a median follow-up of 15 years (10-20), median patient age at the last clinic visit was 21 years (18-31). LUTD was detected in 69 (28.6%) patients. Bilateral disease, female gender, history of childhood bladder bowel dysfunction(BBD), presence of renal scar, and older age (≥7 years) at the time of surgery were significantly associated with LUTD in adulthood. Febrile UTI was detected in 7.9% (19/241) following UNC, whereas 6 needed subureteral injection due to persistent low-grade VUR. No patient developed stage 3 or greater chronic kidney disease, but 11(4.6%) patients developed hypertension and 7(2.9%) had proteinuria. Of 67 sexually active female patients,10(14.9%) had febrile UTIs.Of 49 women in whom pregnancy was observed,4(8.1%) had febrile UTIs, 7(14.2%) had afebrile UTIs and 2(4.1%) had pre-eclampsia during pregnancy, but none had a miscarriage or early labor. Despite VUR control, the incidence of febrile UTI and pre-eclampsia during pregnancy should not be underestimated. In addition, a quarter of patients face LUTD when they reach adulthood. Female patients with bilateral disease, renal scar, and previous childhood BBD have higher risks for these transitional clinical problems.

Evaluation of Risk Factors for Fever and Sepsis after Ureteroscopic Lithotripsy: A Prospective Observational Study

Introduction: Ureteroscopic Lithotripsy (URS) is gaining popularity for the management of ureteral stones and even renal stones due to its high efficacy and minimal invasiveness. While this procedure is generally considered safe with a low complication rate, febrile Urinary Tract Infection (UTI) after URS is not rare. Aim: The aim of the present study is to analyse the risk factors for sepsis and febrile UTI after URS. Materials and Methods: A prospective observational study was conducted at a tertiary referral centre in Jaipur, Rajasthan, from July 1, 2021, to July 1, 2022. The study included 148 patients with obstructive ureteral stones who underwent Ureteroscopy and Laser Stone Lithotripsy (URSL). The patients were divided into two groups: Group-A consisted of patients who developed urosepsis and fever after URSL, and Group-B consisted of patients who underwent URSL without urosepsis. Various risk factors like history of Percutaneous Nephrolithotomy (PCNL), types and sizes of stones, stone locations, duration of operation, mean catheter removal time, and hospital stays were recorded and compared. Chi-square tests and multifactorial logistic regression analyses were used. Results: The incidence of febrile UTI was 12.16% (18 out of 148 patients). The mean age was 42.2±7.2 years in the postoperative febrile group and 42.75±7.44 years in the postoperative non- febrile group. Statistically significant differences were observed between the groups in terms of stone size (p<0.001), duration of operation (p<0.007), stone number (p=0.002), and stone location (p=0.013), which consequently led to an increase in mean catheter removal time (p<0.001) and length of hospital stay (p<0.001). Conclusion: The present study identified several notable risk factors associated with the development of fever and sepsis following URS. Identifying these factors enables healthcare providers to identify patients who may be at a higher risk of postoperative complications and implement appropriate preventive measures.

Risk factors for urinary tract infection in children with urinary urgency.

ABSTRACTPurposeTo identify which independent variable would be strong predictor of febrile urinary tract infection (UTI) in children and adolescents with overactive bladder.Materials and MethodsA search was made of the institute's database for all patients diagnosed with overactive bladder over the preceding four years. Children and adolescents under 18 years of age with overactive bladder and no neurological or anatomical alterations of the lower urinary tract were included in the study. The independent variables were: sex, age, ethnicity (Brazilians of African descendence/others), the presence of urinary urgency, daytime incontinence, enuresis, frequent urination, infrequent voiding (≤3 voids/day), nocturia, holding maneuvers, straining to void, intermittent urinary flow, constipation and encopresis. An analysis was conducted to identify patients with febrile UTI and subsequently determine predictors of this condition. Univariate and multivariate analyses were performed.ResultsOverall, 326 patients (214 girls/112 boys) were evaluated. The mean age of the patients was 7.7±3.19 years (± standard deviation). The incidence of febrile UTI was 39.2%. Being female and infrequent voiding were factors significantly associated with febrile UTI, both in the univariate and multivariate analyses.ConclusionsThese results show that being female and infrequent voiding constituted significant risk factors for a diagnosis of febrile UTI in these children.

Long-term outcomes of cutaneous vesicostomy in patients with neuropathic bladder caused by spina bifida

To evaluate the outcomes of patients who underwent cutaneous vesicostomy for management of neuropathic bladder secondary to spina bifida. We hypothesize that vesicostomy, in select patients, is beneficial to prevent upper urinary tract deterioration (UTD), reduce febrile urinary tract infections (UTIs), and preserve renal function. We performed a retrospective chart review on patients with spina bifida who underwent cutaneous vesicostomy at our institution between 2000 and 2016. Demographic information, indication for vesicostomy, pre and postoperative laboratory/radiologic studies, incidence of febrile UTIs, and urodynamic findings were abstracted. A total of 14 patients (eight females and six males) were identified. The indication for vesicostomy was UTD in four, recurrent febrile UTIs in five, parental request in two, both UTD and recurrent febrile UTIs in two, and both UTI and parental request in one patient. Seven patients had a median of three (range one to five) febrile UTI prior to surgery for cutaneous vesicostomy. Median creatinine level before surgery was 0.26mg/dL (range 0.16-0.97). Either unilateral or bilateral ≥SFU Grade 2 hydronephrosis was present in six patients. Median age at vesicostomy creation was 26.5 months (range 4-96). Mean functional bladder capacity assessed during preoperative urodynamic studies was 107mL (range 20-279), and detrusor sphincter dysynergia was present in all patients. High-grade vesicoureteral reflux (grade ≥3) was present in three patients, all with UTD. Mean follow-up after vesicostomy was 62.4±39.3 months. After vesicostomy, only two of the seven patients with history of febrile UTIs experienced an additional febrile UTI. The median serum creatinine level was 0.36mg/dL (range 0.2-0.58) at last follow-up. Moreover, 11/14 patients had no hydronephrosis and just two patients had unilateral SFU grade 1 hydronephrosis (Table). Worsening UTD, recurrent febrile UTIs, and high-pressure bladder despite maximal medical therapy are several reasons to consider more aggressive management of neuropathic bladders. In young patients, vesicostomy is able to protect the upper urinary tract, decrease rates of febrile UTI, and delay the need for bladder augmentation. Vesicostomy is a safe method for temporary diversion of the lower urinary tract in patients with spina bifida who are refractory to conservative and minimally invasive treatments.

MP23-16 TARGETED ANTIBIOTIC PROPHYLAXIS CAN PREVENT FEBRILE URINARY TRACT INFECTION AFTER REMOVAL OF URETERAL STENTS IN RADICAL CYSTECTOMY PATIENTS WITH INTESTINAL URINARY DIVERSION.

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2017MP23-16 TARGETED ANTIBIOTIC PROPHYLAXIS CAN PREVENT FEBRILE URINARY TRACT INFECTION AFTER REMOVAL OF URETERAL STENTS IN RADICAL CYSTECTOMY PATIENTS WITH INTESTINAL URINARY DIVERSION. Yoshitsugu Nasu, Tadashi Murata, Morito Sugimoto, Atsushi Takamoto, and Noriaki Ono Yoshitsugu NasuYoshitsugu Nasu More articles by this author , Tadashi MurataTadashi Murata More articles by this author , Morito SugimotoMorito Sugimoto More articles by this author , Atsushi TakamotoAtsushi Takamoto More articles by this author , and Noriaki OnoNoriaki Ono More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.744AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy with intestinal urinary diversion has the high incidence of post-operative infective complication. Some patients encountered febrile urinary tract infection (UTI) after removal of the ureteral stents. We started targeted antibiotic prophylaxis, which was chosen appropriate susceptible antibiotics based on urine culture. We evaluated the efficacy of the targeted antibiotic prophylaxis for prevention of febrile UTI after removal of the ureteral stents. METHODS From January 2009 to April 2016, a total of 54 patients who underwent radical cystectomy with intestinal urinary diversion were included. In the first half of the study period (January 2009 to December 2011) included 21 patients, ureteral stents were removed without administration of antibiotic agent. In the last half (January 2012 to April 2016) included 33 patients, targeted antibiotic prophylaxis was done. Prior to removal ureteral stents on post-operative day 7, urine obtained from ureteral stents was cultured and determined the susceptibility of isolated bacteria. Patient received antibiotics for which the isolates were susceptible before the stent removal. Patients were followed up for 2 weeks and febrile UTI were recorded. We compared the incidence of febrile UTI between two study periods. RESULTS Overall the incidence of febrile UTI after stent removal was 22.2% (12/54). In the first half of the study period, the incidence of febrile UTI was 47.6% (10/21) and that of in the last half was 6.1% (2/33). The incidence of febrile UTI was significantly decreased in the last half period (Fisher′s test, p=0.006). Urine cultures positive for bacteria were found in 29 out of 33 patients in the last half period and 33 strains of 11 bacteria species were isolated. The predominant bacteria were E.coli in 5 patients, S. aureus in 4 patients, K.peumoniae in 4 patients and E.cloacae in 4 patients. Five strains (15.2%) of methicillin resistant Staphyococci, 2 strains (6.1%) of extended spectrum β-lactamase producing bacteria and 14 strains (42.4%) of fluoroquinolone-resistant bacteria were isolated. CONCLUSIONS The susceptibility test had an advantage of appropriate antibiotics choice, because 29 out of 33 patients had urine cultures positive for bacteria and miscellaneous and drug-resistant strains were isolated. This targeted antibiotic choice based on urine culture is more effective prophylaxis in radical cystectomy patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e299 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yoshitsugu Nasu More articles by this author Tadashi Murata More articles by this author Morito Sugimoto More articles by this author Atsushi Takamoto More articles by this author Noriaki Ono More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP33-02 CLINICAL CHARACTERISTICS OF POSTOPERATIVE FEBRILE URINARY TRACT INFECTION AFTER URETEROSCOPIC LITHOTRIPSY

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2016MP33-02 CLINICAL CHARACTERISTICS OF POSTOPERATIVE FEBRILE URINARY TRACT INFECTION AFTER URETEROSCOPIC LITHOTRIPSY Jun Nyung Lee, Jae-Wook Chung, Yun-Sok Ha, Seock Hwan Choi, Jae Soo Kim, Gunnam Kim, Bum Soo Kim, Hyun Tae Kim, Tae-Hwan Kim, Eun Sang Yoo, Tae Gyun Kwon, Sung Kwang Chung, and Bup Wan Kim Jun Nyung LeeJun Nyung Lee More articles by this author , Jae-Wook ChungJae-Wook Chung More articles by this author , Yun-Sok HaYun-Sok Ha More articles by this author , Seock Hwan ChoiSeock Hwan Choi More articles by this author , Jae Soo KimJae Soo Kim More articles by this author , Gunnam KimGunnam Kim More articles by this author , Bum Soo KimBum Soo Kim More articles by this author , Hyun Tae KimHyun Tae Kim More articles by this author , Tae-Hwan KimTae-Hwan Kim More articles by this author , Eun Sang YooEun Sang Yoo More articles by this author , Tae Gyun KwonTae Gyun Kwon More articles by this author , Sung Kwang ChungSung Kwang Chung More articles by this author , and Bup Wan KimBup Wan Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1359AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES E. coli is known to be the most common pathogen causing urinary tract infections (UTI), accounting for 85% of community-acquired and 50% of hospital-acquired infections. Therefore, fluoroquinolone or cephalosporin is commonly used as prophylactic antibiotics for ureteroscopic lithotripsy (URS). Despite of using these prophylactic antibiotics, febrile UTI after URS is not uncommon. We aimed to analyze the risk factors and causative pathogen of febrile UTI after URS in this study. METHODS From January 2013 to June 2015, 304 patients underwent URS. The rate of postoperative febrile UTI and causative pathogen were verified and risk factors of the postoperative febrile UTI were analyzed with logistic regression analysis. All patients did not show pyuria on preoperative urinalysis. Intravenous quinolone were administered perioperatively for 1 day and oral antibiotics were administered for 5 days postoperatively. Febrile UTI was defined as the body temperature of > 38 °C with pyuria within 1 week after the operation. RESULTS Overall incidence of febrile UTI was 14.1 % (43/304). Of 43 patients with febrile UTI, true pathogens were cultured at blood or urine in 19 patients (44.2%) and definite pathogens were not cultured in 24 patients (55.8%). As causative pathogen for febrile UTI, P. aeruginosa was the most commomly cultured in 11/43 patients (25.6%) and each of E. coli, S. capitis, S. epidermidis, Proteus mirabilis, Enterococcus faecalis, Enterobacter cloacae, Cirtobactor amalonaticus, and Achromobacter xylosoxidans was cultured in 1/43 patients (2.3%), respectively. On logistic regression analysis, the size of a stone (p=0.026) and operation time (p=0.007) were independent risk factors of febrile UTI after URS. Cut-off value of operation time and stone size were 70 minutes (sensitivity: 58.1 %, specificity: 61.7 %) and 9.85 mm (sensitivity: 62.8 %, specificity: 49.8 %), respectively. CONCLUSIONS Despite adequate prophylactic antibiotics were used, postoperative febrile UTI after URS developed in 14.1% at our institution. Although causative pathogens were not identified about half of patients with febrile UTI, P. aeruginosa was the most common true pathogen. Therefore, appropriate antibiotic therapy to cover these pathogens will be required for the management of postoperative febrile UTI after URS. Stone size and the operation time can be considered as the risk factors of febrile UTI after URS. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e436 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jun Nyung Lee More articles by this author Jae-Wook Chung More articles by this author Yun-Sok Ha More articles by this author Seock Hwan Choi More articles by this author Jae Soo Kim More articles by this author Gunnam Kim More articles by this author Bum Soo Kim More articles by this author Hyun Tae Kim More articles by this author Tae-Hwan Kim More articles by this author Eun Sang Yoo More articles by this author Tae Gyun Kwon More articles by this author Sung Kwang Chung More articles by this author Bup Wan Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Association of Renal and Bladder Ultrasonography Findings with Urinary Tract Infection Recurrence, High-Grade Vesicoureteral Reflux, and Renal Scarring

Introduction: This study investigated whether renal and bladder ultrasonography (RBUS) findings performed in children with the first incidence of febrile urinary tract infection (UTI) can predict UTI recurrence, high-grade vesicoureteral reflux (high-grade VUR), or acquired renal scarring (aRS). Methods: In all, 917 children who were admitted to our hospital from January 2001 to October 2010, owing to the first incidence of febrile UTI were enrolled in this study. All children underwent RBUS during admission. The mean follow-up was 7.9 months (standard deviation [SD]±13.3). UTI recurrence rates were calculated according to various clinical parameters. By using bivariate and multiple logistic regression analyses, we determined whether age, sex, abnormal RBUS findings, abnormal dimercaptosuccinic acid renal scan findings, or RBUS findings parameters were predictive of UTI recurrence, high-grade VUR, or aRS. Results: On RBUS, hydronephrosis and congenital anomaly of the kidney and urinary tract significantly predicted UTI recurrence. A small kidney, hydroureter, hydronephrosis, cortical thinning, and increased parenchymal echogenicity significantly predicted high-grade VUR. However, their odds ratios (OR) are low compared to normal RBUS findings (recurrent UTI: OR 0.432 and 0.354 vs. 0.934, respectively, high-grade VUR: .019, 0.329, 0.126, 0.058, and 0.188 vs. 2.082, respectively). No RBUS findings significantly predicted aRS. Recurrent UTI, high-grade VUR, and abnormal RBUS findings significantly predicted aRS (OR of 4.80, 4.61, and 2.58, respectively). Conclusion: RBUS is necessary to exclude severe congenital renal scarring, obstructive uropathy, and renal abscess at the first incidence of febrile UTI and is helpful in determining the need for subsequent clinical imaging. Key words: Renal sonogram; Urinary tract infection recurrence; High-grade vesicoureteral reflux; Acquired renal scarring

Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics.

Urinary tract infection (UTI) is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through infections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to find a safer, effective and acceptable alternative. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vaccinium Macrocarpon (cranberry), commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus (LA-5) and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli (E. coli) 83972 has resulted in subjective benefit and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions, other than antibiotic prophylaxis, for the prevention of recurrent UTI have been tried and, although showing some promise, they do not provide so far a definitive effective answer. Finding suitable alternatives still requires further high quality research of those seemingly promising interventions.

Continuous antibiotic prophylaxis reduces the risk of febrile UTI in children with asymptomatic antenatal hydronephrosis with either ureteral dilation, high-grade vesicoureteral reflux, or ureterovesical junction obstruction

BackgroundThe efficacy and utility of continuous antibiotic prophylaxis (CAP) in children with congenital antenatal hydronephrosis (ANH) is uncertain. The literature has both supportive and contradictory evidence. The growing trend not to place children with ANH on CAP has created varied clinical practice based on anecdotal individual case characteristics. Our goal was to compare individual infant characteristics between those children who were maintained on CAP to those that were not to try to determine predisposing risk factors to febrile. MethodsAll electronic medical records (EMRs) of children referred to our institution for congenital ANH over a period from 2001 to 2011 were examined. We excluded those referred for urinary tract infection (UTI) who had a history of congenital ANH. We also excluded those with incomplete records, or follow-up less than 2 years. Children were divided into two groups: those maintained on CAP (YCAP) and those not maintained on CAP (NCAP). Our primary endpoint was febrile UTI. Follow-up was at least 24 months. Demographic, perinatal and postnatal clinical data were recorded. Statistical analysis was performed using STATA Version 11.1. ResultsOf the 405 children fitting inclusion criteria, 278 (68.6%) children were maintained on CAP and 127 (31.4%) were not on CAP. The incidence of prematurity, oligohydramnios, perinatal respiratory complications, use of perinatal antibiotics, circumcision status, renal anomalies, associated medical diagnoses, and low birth weight did not differ between the two groups. Overall the incidence of febrile UTI during the follow-up period was 22.2%. The incidence of febrile UTI between the YCAP and NCAP groups was significant (YCAP = 7.9% and NCAP 18.7%, p = 0.021). Multivariate logistic regression using CAP as the dichotomous dependent variable revealed that ureteral dilation, high-grade vesicoureteral reflux (VUR), and ureterovesical junction (UVJ) obstruction were independent risk factors for febrile UTI. More specifically, children with ureteral dilation >11 mm NOT maintained on CAP had a 5.54 (OR = 5.54; CI = 3.15–7.42, p = 0.001) fold increased risk of febrile UTI compared to those maintained on CAP. ConclusionsThe presence of ureteral dilation, high grade VUR, and UVJ obstruction were independent risk factors for development of UTI in children with congenital ANH. Therefore CAP may have a significant role in reducing the risk of febrile UTI in children with ANH with those identifiable risk factors, but otherwise seems unnecessary.

Incidence and Risk Factors of Urinary Tract Infection after Endoscopic Therapy for Vesicoureteral Reflux in Children

Purpose: The purpose of this study is to evaluate the incidence and risk factors of febrile urinary tract infection (UTI) after endoscopic therapy for vesicoureteral reflux (VUR). Materials and Methods: Analysis of the clinical data of 88 children (128 refluxing renal units; male 60%, female 40%) in a single institution during March 2011-June 2013 including age, gender, sorts and volume of agent for injection, preoperative VUR grade, recurrent UTI, bladder dysfunction, nephropathy, postoperative VUR, urinalysis, and urine culture results was performed retrospectively. All patients were followed for three to 62 months (average 25 months). Results: After the first injection, the complete resolutions rate of VUR (by ureter) was 72.7%, consisting of grade I 4 (90%), grade II 11 (84.6%), grade III 29 (76.3%), grade IV 33 (66%), and grade V 93 (72.7%) ureters. Preoperative UTI and febrile UTI were present in 81 (92.0%) and 49 patients (55.7%), respectively. Preoperative recurrent UTI and febrile UTI were observed in 53 (60.2%) and 30 patients (34.1%), respectively. Postoperative UTI and febrile UTI occurred in eight (9.1%) and in five patients (5.7%), respectively. In multivariate analysis, only preoperative recurrent UTI (odds ratio [OR], 0.17; p=0.04) and bladder trabeculation (OR, 0.104; p=0.038) were independent variables after endoscopic therapy. Conclusions: Our data support that the successful endoscopic correction of VUR is associated with a low incidence of febrile UTI. The highest risk factor for post injection UTI is preoperative recurrent UTI and bladder dysfunction. Therefore, patients with preoperative recurrent UTI and bladder dysfunction require careful observation after endoscopic therapy for VUR.

Should Antibiotics Be Given Prior to Outpatient Cystoscopy? A Plea to Urologists to Practice Antibiotic Stewardship

BackgroundAntimicrobial resistance is a major health problem, caused primarily by overuse of antibiotics in clinical situations in which they are not necessary. Practice guidelines recommend that antibiotics be given before outpatient cystoscopy to prevent symptomatic urinary tract infection (UTI). ObjectiveTo determine the frequency of febrile UTI after outpatient flexible cystoscopy in antibiotic-naive bladder tumor patients. Design, setting, and participantsA total of 2010 consecutive outpatients with bladder tumors were entered into a prospective registry study. All patients underwent cystoscopy after they submitted a voided urine sample for culture. Significant bacteriuria was defined as >104 colony-forming units per milliliter with a single organism. Patients were stratified for known risk factors for UTI. InterventionPatients underwent flexible cystoscopy and received no antibiotics immediately before or after cystoscopy. They were followed for 30 d for onset of febrile UTI. Outcome measurements and statistical analysisThe end point was incidence of febrile UTI within 30 d of cystoscopy. Febrile UTI was defined as temperature >38°C and dysuria, or having received antibiotics from an outside physician for urinary symptoms. Results and limitationsOf the 2010 patient cystoscopies, 489 (24%) had asymptomatic bacteriuria, and 1521 (76%) had sterile urine. Thirty-nine patients (1.9%) developed febrile UTI ≤30 d after cystoscopy—4.5% in colonized patients and 1.1% in uninfected patients (p=0.02). All UTIs resolved in ≤12–24h with oral antibiotics. None of the patients was admitted for bacterial sepsis. Limitations of the study are that it is a single-surgeon experience in one institution, and results may not apply to other patient populations. ConclusionsAntibacterial therapy before outpatient flexible cystoscopy does not appear necessary in bladder tumor patients who have no clinical signs or symptoms of acute UTI, including asymptomatic bacteriuria. Antibiotic stewardship is the responsibility of all urologists.

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

To evaluate the incidence of febrile urinary tract infection (UTI) after successful endoscopic correction of intermediate and high-grade vesicoureteral reflux (VUR). Medical records of 1271 consecutive children (male, 411; female, 903) who underwent successful endoscopic correction of VUR were reviewed. Factors potentially influencing postoperative UTIs, such as history of presentation, age, sex, grade of VUR, renal scarring, and agent used for the endoscopic injection, were analyzed. Febrile UTI developed in 73 children (5.7%) after successful endoscopic correction of VUR. Thirty-nine children had a single episode of UTI, and 34 children had two or more episodes at 1 month to 5.9 years (median, 1 year) after correction of VUR. With multivariate analysis, female sex (P < .001), history of preoperative bladder/bowel dysfunction (BBD; P = .005), and BBD after endoscopic correction (P = .001) were revealed to be the most important independent risk factors for a febrile UTI after successful correction of VUR. The incidence of febrile UTIs after successful correction of intermediate and high grade VUR is low. Female sex and BBD were the most important risk factors in the development of febrile UTI. Our data supports the importance of assessing bladder and bowel habits in older children with febrile UTIs after endoscopic correction of VUR.

Risk factors for febrile urinary tract infection in children with myelodysplasia treated by clean intermittent catheterization

To identify the factors involved in the incidence of febrile urinary tract infection (UTI) in a retrospective study of children with myelodysplasia who were treated by clean intermittent catheterization. A total of 76 myelodysplastic children were included in the present study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both a univariate analysis and a multiple logistic regression analysis. Of the 76 patients, 19 (25%) had one or more episodes of febrile UTI. A univariate analysis showed low bladder compliance (<10 mL/cmH2O), detrusor overactivity, bladder trabeculation and the presence of vesico-ureteral reflux (VUR) to be significant factors in the incidence of febrile UTI. The presence of detrusor overactivity and a low bladder compliance, in addition to the presence of VUR, were found to be significant factors for the incidence of febrile UTI using a multivariate analysis. These results demonstrate that, in addition to VUR, urodynamics linked to bladder storage function disorder appear to be directly correlated with the cause of febrile UTI in children with myelodysplasia.

Relationship between Febrile Urinary Tract Infection and Urodynamics in Myelodysplastic Children with Vesicoureteral Reflux

Objective: We conducted a retrospective study in order to identify factors that may predict the incidence of febrile urinary tract infection (UTI) in myelodysplastic children with vesicoureteral reflux (VUR). Methods: A total of 23 myelodysplastic children with persistent VUR who were managed by clean intermittent catheterization (CIC) were eligible for this study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both univariate analysis and multiple logistic regression analysis. Results: Of 23 patients, 10 (43%) had had one or more episodes of febrile UTI. Both univariate and multivariate analyses showed a statistically significant relationship between low bladder compliance (<10 ml/cm H₂O) and episodes of febrile UTI. Conclusion: These results demonstrated that the urodynamics linked to bladder function disorder in the filling phase appear to be correlated with the incidence of febrile UTI in myelodysplastic children with VUR who are managed by CIC.