Role Of Antibiotic Prophylaxis Research Articles

Antibiotic Prophylaxis and Treatment for Cardiac Device Infections.

Cardiac device infections (CDIs) are a serious complication in patients with implanted devices, resulting in increased morbidity, prolonged hospital stay, and increased healthcare costs. The effective management of these infections involves a combination of appropriate antibiotic therapy and preventive strategies aimed at reducing the risk of infection. The role of antibiotic prophylaxis in infection prevention is crucial, including the emerging use of antibiotic-supported tools and other local antibiotic delivery systems, which may reduce the risk of infection at the device implant site. In this contemporary review, we provide an overview of the prophylactic treatment and different antibiotic regimens for the treatment of CDIs, emphasizing early diagnosis, appropriate choice of antibiotics, and individualized treatment.

Antibiotic prophylaxis in digestive endoscopy: Guidelines from the French Society of Digestive Endoscopy

AbstractDigestive endoscopy is a highly dynamic medical discipline, with the recent adoption of new endoscopic procedures. However, comprehensive guidelines on the role of antibiotic prophylaxis in these new procedures have been lacking for many years. The Guidelines Commission of the French Society of Digestive Endoscopy (SFED) convened in 2023 to establish guidelines on antibiotic prophylaxis in digestive endoscopy for all digestive endoscopic procedures, based on literature data up to September 1, 2023. This article summarizes these new guidelines and describes the literature review that fed into them.

An Update on Open Inguinal Hernia Repair in Adults: Review Article

Open inguinal hernia repairs are a common general surgical procedure, and it can be divided into mesh-based repairs and sutured based repairs. Mesh-based repairs are the most popular open inguinal hernia repair with the Lichtenstein repair being the most common surgical procedure. The sutured based repairs are not as commonly performed with the Shouldice repair being the most popular repair, but the Desarda repair is slowly emerging as a viable sutured based inguinal hernia repair. We have conducted this review article to look at the varies types of mesh based and sutured based repairs for open inguinal hernia repair including their complications and recurrence rate. We also looked at the effect of chronic pain and the role of antibiotic prophylaxis in open inguinal hernia repair.

Understanding and Addressing Vesicoureteral Reflux in Pediatric Patients: A Comprehensive Exploration of Diagnostic Strategies, Challenges, and Optimized Management Approaches

Vesicoureteral reflux (VUR) in pediatric patients poses a multifaceted challenge for clinicians, necessitating a thorough exploration of diagnostic strategies, challenges, and optimized management approaches. This article delves into the nuanced aspects of understanding VUR in the pediatric population. Diagnostic modalities, ranging from conventional voiding cystourethrography to advanced imaging techniques, are scrutinized for their efficacy in identifying reflux severity and associated complications. Challenges in the diagnostic process, including age-related variations and the impact of evolving clinical presentations, are discussed. The article also addresses the intricacies of managing pediatric VUR, emphasizing the importance of tailored treatment plans based on reflux grade, patient age, and concurrent conditions. Surgical and non-surgical interventions are appraised, highlighting their respective advantages and limitations. Additionally, the role of antibiotic prophylaxis in preventing urinary tract infections and preserving renal function is explored. Through a comprehensive examination of the diagnostic and management landscape, this article aims to provide clinicians with a nuanced understanding of pediatric VUR, enabling them to navigate the complexities of diagnosis and deliver optimized care to young patients with this urological condition.

Review of the national usage of antibiotics in arthroplasty surgery: a need for evidence-based prescribing.

Surgical site infections (SSI) remain one of the most serious complications of arthroplasty surgery. The role of antibiotic prophylaxis in preventing SSI post-arthroplasty is well established. However, there is considerable heterogeneity in prophylactic prescribing across the United Kingdom (UK), which is contradicted by the contemporaneous evidence. This descriptive study aimed to compare the current first-line antibiotic recommendations across hospitals in the UK and The Republic of Ireland for elective arthroplasty procedures. The MicroGuide mobile phone application was used to access hospital antibiotic guidelines. First-line antibiotic recommendation and dosing regimen for primary elective arthroplasties were recorded. A total of nine distinct antibiotic regimens were identified through our search. The most frequently used first-line antibiotic was cefuroxime. This was recommended by 30 of the 83 (36.1%) hospitals in the study. This was followed by a combination of flucloxacillin and gentamicin, which was used by 38 of 124 (31%) hospitals. There was also significant heterogeneity in dosing regimens. A single prophylactic dose was most commonly recommended (52%); 4% of hospitals recommended two prophylactic doses, 19% three doses and 23% four doses. Single-dose prophylaxis is recognised as at least noninferior to multiple-dose prophylaxis in primary arthroplasty. There is considerable variation in the local antibiotic recommendations for surgical site prophylaxis post-primary arthroplasty surgery, with respect to both recommended first-line antibiotic and dosing regimens. With increasing emphasis on the importance of antibiotic stewardship and the emergence of antibiotic resistance, this study highlights the need for an evidence-based approach to prophylactic dosing across the UK.

Role of Antibiotic Prophylaxis and GCSF Support in Preventing Systemic Anticancer Therapy-Associated Toxicities in HIV Infected Cancer Patients: A Case Series

This is a case series report of five HIV-positive patients diagnosed with non-AIDS-defining cancer who received the combination of ART and chemotherapy. There is an increasing incidence of non-AIDS-defining cancers, such as breast cancer, lung cancer, hepatocellular carcinoma, prostate cancer, colorectal cancer, and Hodgkin’s lymphoma. The purpose of this study is to see the impact of appropriate antibiotics prophylaxis and G-CSF Support in preventing the toxicities associated with systemic anti-cancer therapy (SACT) in HIV Patients. Keywords: Human Immunodeficiency Virus, Acquired Immune Deficiency Syndrome, Anti-Retroviral Therapy, AIDS Defining Cancer, systemic anti-cancer therapy (SACT), Non-Aids Defining Cancer.

The Role of Antibiotic Prophylaxis in Anastomotic Leak Prevention during Elective Colorectal Surgery: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Despite several perioperative care advancements and innovations in surgical procedures and technologies, the incidence rate of anastomotic leaks (ALs) after colorectal surgery has not substantially decreased. Gut microbiota can play a critical role in the healing process of anastomotic tissue and alterations in its composition may be largely to blame for anastomotic insufficiency. The use of specific antibiotics for preoperative large bowel decontamination could significantly influence the rate of ALs. The aim of this study was to systematically assess the various antibiotic prophylactic regimen strategies for primary prevention of ALs during colorectal surgery, in view of the available evidence. Methods: A systematic review of the literature was conducted, and randomized clinical trials (RCTs) analyzing prophylactic antibiotic bowel preparation in colorectal surgery were included. PubMed, Embase, the Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials were searched from inception through to 30 November 2022. The methodological quality of the included trials was evaluated. The primary outcome was AL rate; secondary outcomes were superficial/deep surgical site infections (SSIs). The PRISMA guidelines were used to carry out the present systematic review. Results: Thirteen RCTs published between 1977 and 2022, with a total of 4334 patients were included in the meta-analysis. Antibiotic prophylaxis was administered orally in 11/13 studies and intravenously in 2 studies. Patients randomly assigned to antibiotic prophylaxis, regardless of the regimen, had a reduced risk of ALs (p = 0.003) compared to mechanical bowel preparation (MBP) alone. The use of antibiotic prophylaxis was also more effective in significantly reducing SSIs (p < 0.001). Conclusions: The evidence points to an advantage of oral antibiotic prophylaxis in terms of AL rate, a significant contributor to perioperative morbidity, mortality, and rising healthcare expenditures. In light of such results, the use of antibiotic prophylaxis should be strongly encouraged prior to colorectal surgery.

Infectious complications of non-surgical biliary tract manipulation in paediatric patients. Role of antibiotic prophylaxis

BackgroundInfections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin–tazobactam for this purpose. ObjectiveWe aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol. Materials and methodsEpidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010–2019). Results113 procedures in 37 patients, median age 4 years (IQR 1–8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant. ConclusionsNSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia.

The Risk of Opportunistic Infections and the Role of Antibiotic Prophylaxis in Patients on Checkpoint Inhibitors Requiring Steroids.

Immune-related adverse events (irAEs) often require treatment with high-dose systemic steroids (SS) and other immunosuppressive agents (ISAs). NCCN Guidelines recommend prophylactic antibiotics for Pneumocystis jirovecii pneumonia (PJP) for patients receiving prolonged SS/ISAs. However, there is a paucity of evidence regarding the incidence of opportunistic infections (OIs) and non-OIs and the role of prophylactic antibiotics in patients on SS/ISAs for irAEs. A retrospective analysis was conducted of patients treated using immune checkpoint inhibitor (ICI) therapy at 5 MedStar Health hospitals from January 2011 to April 2018. OIs were defined per the Infectious Diseases Society of America guidelines for the prevention and treatment of OIs in patients with HIV. The study cohort included patients who received ≥20 mg daily of a prednisone equivalent for ≥4 weeks to manage irAEs. The study cohort identified 112 (15%) of 758 total patients treated using ICIs. Baseline characteristics included the following: median age was 64 years, 74% (n=82) of patients were White, 89% (n=100) had an ECOG performance status ≤1, 61% (n=68) had melanoma, 19% (n=21) had non-small cell lung cancer, 45% (n=50) were treated using an anti-PD-(L)1 ICI, and 33% (n=37) were treated using an anti-PD-1/anti-CTLA-4 combination. The median starting SS dose was 100 mg of a prednisone equivalent, and 25% of patients required additional ISAs, with infliximab (n=15) and mycophenolate mofetil (n=9) being the most common. We found that 20% (n=22) of patients developed any infection, including 7% (n=8) with OIs (oral candidiasis [n=4], nondisseminated varicella zoster infection [n=2], PJP [n=1], and Listeria monocytogenes endophthalmitis [n=1]) and 13% (n=14) with non-OIs (most common: Clostridium difficile and pneumonia [n=5 each]). PJP prophylaxis with sulfamethoxazole/trimethoprim was given to 13% (n=14) patients, of whom 43% (n=6) developed OIs/non-OIs. Our study highlights the fundamental issues for patients on ICI therapy who require SS/ISAs for irAEs: the degree of immunosuppression and the relative risk of OI. We noted a low incidence of OIs overall and breakthrough infections despite PJP prophylaxis. We question whether PJP prophylaxis is efficacious or necessary. Prospective trials are required to answer these questions.

Role of antibiotic prophylaxis on surgical site infection prevention in a low-risk population undergoing laparoscopic cholecystectomy: A randomized controlled study

ObjectiveTo compare the incidence of surgical site infections (SSIs) in low-risk patients undergoing laparoscopic cholecystectomy (LC) with pre-operative antibiotics versus no pre-operative antibiotics administration. Study designRandomized controlled study. SettingHepatobiliary department, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Pakistan, from Jul 1, 2018, to Jun 30, 2021. MethodsThis is a prospective, open-label, randomized study. Individuals scheduled for laparoscopic cholecystectomy who met the inclusion requirements were randomly assigned to two groups. Group A patients received pre-operative antibiotics (intravenous cefazolin 2-g), and group B patients were operated on without administration of pre-operative antibiotics. Post-operatively, patients were studied for the occurrence of SSIs for 30 days. ResultsThe mean age of patients in group A was 40.6 + 5.2 years, while group B was 41.04 + 5.03. The male to female ratio was 1:3. Gender distribution showed female dominance in both groups, i.e., 78.74% in group A and 76.80% in group B. The incidence of SSI in group A was 3.98%, while in group B was 4.9% (p-value = 0.584). No statistical significance was found while comparing both groups' age, gender, operative duration, and hospital stay. ConclusionThis study showed comparable results between both groups, and prophylactic antibiotics have no impact in preventing SSIs. In low-risk individuals undergoing laparoscopic cholecystectomy, the incidence of SSIs is quite low, and prophylactic antibiotics can be avoided.

Infektivni endokarditis

Infective endocarditis (IE) was first described more than 350 years ago. It is a disease of the endocardial surface of the heart. Infection typically involves the cardiac valves (native or prosthetic) or an indwelling cardiac device. The cardiac manifestations could include valvular vegetation, abscess, periannular extension of infection. The clinical manifestations of IE are protean and can involve all organic system. Early clinical suspicion and rapid diagnosis are crucial for adequate treatment and reduction of complications and mortality. Integrating clinical results, imaging, and biomarkers are traditionally applied in suspected IE modified Duke criteria. New imaging technologies, such as multi-slice computed tomography, photon-emission computed tomography, and magnetic resonance imaging, might add value to conventional echocardiography in diagnosis and management of IE. Complications from IE are common, and include congestive heart failure, embolism, septic shock, invasive infection, prosthetic valve dehiscence, heart block, and mycotic aneurysm. Intravenous antibiotics are first-line therapy with cardiac surgery being reserved for certain complications of IE and/or for clinical situations in which there is a high risk of complications. Longstanding controversies such as the timing of surgery or the role of antibiotic prophylaxis have not been resolved.

Antibiotic Prophylaxis Prior to Urodynamic Study in Patients with Neurogenic Bladder and Asymptomatic Bacteriuria: A Randomized Controlled Trial

Background: Symptomatic urinary tract infection (UTI) is a common complication after urodynamic study (UDS). While the role of antibiotic prophylaxis before UDS is controversial. Objective: To compare the incidence rate of symptomatic UTI after UDS in patients with and without antibiotic prophylaxis. Materials and Methods: We conducted a randomized, open-label, noninferiority controlled trial in adults with asymptomatic bacteriuria who were undergoing UDS. The participants were randomly assigned (1:1) to receive either gentamicin 5 mg/kg plus ampicillin 1-gram intravenous (IV) infusion 1 hour before UDS or no prophylaxis. The primary outcome was an incidence rate of symptomatic UTI within 48 hours after UDS. Secondary outcomes were adverse effects and microbiological clearance of urine at 48 hours after UDS. The study was terminated early after the first interim analysis due to safety concerns. Results: 26 patients were enrolled, median age was 52 years (range, 25 to 75 years), 69.2% were male, and all had a neurogenic bladder as indication for UDS. Of these, 13 patients each were allocated to the antibiotic prophylaxis group and the non-antibiotic prophylaxis group. In the antibiotic prophylaxis group, 12/13 (92.3%) received gentamicin plus ampicillin and one received ceftriaxone. The incidence rate of symptomatic UTI after UDS was significantly higher in patients with no antibiotic prophylaxis (5/13; 38.5%) than those who received antibiotic prophylaxis (0%) (p=0.04). No adverse drug events were observed. The microbiological clearance in urine at 48 hours after UDS was significantly higher in patients who received antibiotic prophylaxis (8/11; 72.7%) compared to those without antibiotic prophylaxis (0/13; 0%) (p&lt;0.001). Conclusion: Antibiotic prophylaxis reduced the incidence of symptomatic UTI in patients with neurogenic bladder and asymptomatic bacteriuria who were undergoing UDS. A single-dose of antibiotics within an hour prior to UDS seems to be a proper option. Keywords: Antibiotic prophylaxis; Asymptomatic bacteriuria; Urodynamic study

Antibiotic Prophylaxis against Surgical Site Infection after Open Hernia Surgery: A Systematic Review and Meta-Analysis

Objective: The role of antibiotic prophylaxis (AP) in the prevention of surgical site infection (SSI) after hernia repair is debated. We conducted this systematic review and meta-analysis to assess the evidence on the value of prophylactic antibiotics in reducing the risks of SSI after open hernia surgery. Methods: We ran an online and manual search to identify relevant randomized controlled trials that compared prophylactic antibiotics to nonantibiotic controls in patients undergoing open surgical hernia repair. Data on SSI risk were extracted and pooled as risk ratios (RRs) with 95% confidence intervals (95% CIs), using RevMan software. We further used the Cochrane risk of bias tool and GRADE assessment to evaluate the quality of generated evidence. Results: Twenty-nine studies (N = 8,616 patients) were included in the current analysis. Antibiotic prophylaxis reduced the risk of SSI in open hernia repair patients (RR = 0.65, 95% CI = 0.53, 0.79). Subgroup analysis showed a significant benefit for antibiotics in mesh repair patients (RR = 0.60, 95% CI = 0.48, 0.76) yet no significant difference in SSI risk after herniorrhaphy (RR = 0.86, 95% CI = 0.54, 1.36). In addition, AP was associated with a significant reduction in superficial SSI risk (RR = 0.56, 95% CI = 0.43, 0.72) but not deep SSI (RR = 0.70, 95% CI = 0.30, 1.62). Further analysis showed a significant reduction in SSI risk with amoxicillin/clavulanic acid and cefazolin but not with cefuroxime. Conclusion: The present meta-analysis suggests that AP is beneficial prior to open mesh hernia repair. However, the quality of evidence was low, and further well-designed trials are needed.

Infectious complications of non-surgical biliary tract manipulation in paediatric patients. Role of antibiotic prophylaxis

BackgroundInfections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin–tazobactam for this purpose. ObjectiveWe aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol. Materials and methodsEpidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010–2019). Results113 procedures in 37 patients, median age 4 years (IQR 1–8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant. ConclusionsNSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay.

Radiologically Inserted Gastrostomy (RIG) at a Tertiary Center: Periprocedural Safety including Rationalization of Antibiotic Prophylaxis

Abstract Introduction Long-term percutaneous enteral nutrition forms an important part of treatment for patients with an inability to meet nutrient requirements orally. Radiologically inserted gastrostomy (RIG) is an alternative to the traditionally performed percutaneous endoscopic gastrostomy technique. However, there is marked heterogeneity in the way that RIG is performed. In addition, the role for antibiotic prophylaxis during RIG insertion is not clearly established. This study aimed to assess the safety of RIG insertion using our technique including the role of antibiotics in RIG insertion. Method Retrospective study over 5 years at a tertiary teaching hospital. Periprocedural or early complications within the first 2 weeks of the procedure were collected and correlated with the use of prophylactic antibiotics. Results A total of 116 patients met the inclusion criteria. 18-French tube was used in 96.6%. Note that 58.6% of procedures were done with intravenous sedation. Prophylactic 1 g cefazolin was used in 70 patients with 1 case of infection. Procedures were performed without antibiotics in 46 patients with 3 infections, p = 0.20.There were two major complications (1.7%) consisting of right gastric artery injury requiring embolization and gastric wall injury requiring laparotomy. There were 12 minor complications (10.3%) including 4 cases of infection, 3 of severe pain, 1 of minor bleeding, 2 of early dislodgement, and 2 of leak/bypass of gastric contents around the tube. Conclusion The technique used for RIG insertion at our institution results in a low complication rate. In addition, this study shows no significant difference in early peristomal infection rate with the use of antibiotic prophylaxis.

Risk factors for postoperative intracranial infections during endoscopic endonasal skull base surgery and the role of antibiotic prophylaxis

Risk factors for postoperative intracranial infections during endoscopic endonasal skull base surgery and the role of antibiotic prophylaxis

Antibiotic Prophylaxis for Percutaneous Endoscopic Gastrostomy in Children: A Randomised Controlled Trial.

Paediatric studies on the role of antibiotic prophylaxis in the prevention of postoperative infections in children undergoing percutaneous endoscopic gastrostomy (PEG) are lacking. The aim of this study was to assess if a single dose of co-amoxiclav before PEG can decrease the rate of peristomal wound and systemic infection in children. In this prospective, randomised, double-blind, multicentre trial, children undergoing PEG were randomized to antibiotic prophylaxis with co-amoxiclav versus placebo and the rate of local and systemic infections were assessed. Of the 106 patients considered for inclusion, 49 patients were randomized. In the per-protocol analysis, the occurrence of wound infection was 5% (1/20) in the antibiotic group and 21% (4/19) in the placebo group (P = 0.13, 16% difference in proportions, odds ratio [OR] 0.19, 95% confidence interval [CI] 0.02-1.9). The occurrence of systemic infection was 9% (2/22) in the antibiotic group and 27.2% (6/25) in the placebo group [P = 0.17, 18% difference in proportions, OR 0.32, 95% CI 0.06%-1.80%]. Similar results were obtained in intention-to-treat analysis. Interestingly, the overall infection rate was significantly higher in the placebo group as compared with the antibiotic group (40% vs 13.6%; P = 0.04) and the duration of hospital stay was significantly longer in the placebo group as compared with the antibiotic group (4.4 ± 1.6 vs 3.5 ± 1.05; P = 0.02). The number-needed-to-treat (NTT) to prevent 1 peristomal infection on average are 6.7 patients. A preoperative dose of co-amoxiclav reduces the overall infection rate and the duration of hospital stay. Our data suggest that antibiotic prophylaxis should be recommended in every children undergoing PEG placement.

Role of Antibiotic Prophylaxis in the Management of Antenatal Hydronephrosis, Vesicoureteral Reflux, and Ureterocele in Infants.

Widespread prenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. Antenatal hydronephrosis (AHN) and vesicoureteral reflux (VUR) are among the most common congenital anomalies diagnosed in utero or after birth. Pediatric urologists frequently rely on continuous antibiotic prophylaxis (CAP) for managing AHN, VUR, and ureterocele, unless definitive treatment is performed. The main aim of antibiotic prophylaxis (ABP) is to prevent urinary tract infection and long-term complications. Nevertheless, the efficacy of ABP has been a source of considerable debate, and pediatricians have varied opinions on who would benefit from ABP. In this review article, we searched the currently available literature, for evidence of the role of ABP in the setting of AHN, VUR, and ureterocele. Most of our studies showed a limited benefit of ABP for HN and VUR. The data on the use of CAP in the management of ureterocele is scarce. However, due to the involvement of independent risk factors and other variables, a conclusion cannot be drawn from these studies alone. Pediatric urologists are urged to conduct randomized controlled trials to compare patients followed up with and without ABP. Given the lack of guidelines, an individualized approach should be used for the use of ABP, until precise guidelines and recommendations are developed.

The role of antibiotic prophylaxis in mild to moderate isolated hydronephrosis detected in antenatal screening.

PurposeTo determine whether continuous antibiotic prophylaxis (CAP) could prevent urinary tract infection (UTI) in mild to moderate antenatal isolated hydronephrosis (IH), characterized by hydronephrosis without ureter and bladder abnormalities, and anteroposterior renal pelvis diameter <16 mm and the Society for Fetal Urology grade <4, in neonatal renal ultrasound.Materials and MethodsEighty neonates aged 7 to 30 days, with antenatal hydronephrosis and mild to moderate IH on neonatal renal ultrasound, were recruited from August 2015 to December 2016. Neonates were randomly assigned to CAP until hydronephrosis resolution or aged 12 months (CAP group, n=40) or to watchful observation (control group, n=40). The primary outcome was UTI. The probability of UTI was compared between the randomized groups using the Kaplan–Meier method and the log-rank test.ResultsNonadherence occurred in 6/40 parents in the CAP arm (15.0%). Thus, only 34 patients received CAP. UTI occurred in 5/34 patients in the CAP group (14.7%) and in 4/40 controls (10.0%). The probability of UTI was increased in the CAP group (hazard ratio, 1.38; 95% confidence interval, 0.37–5.16; p=0.63). UTI caused by cotrimoxazole resistant bacteria was four times higher in the CAP group than in controls (relative risk, 4.0; 95% confidence interval, 1.2–13.5; p=0.02). The trial was prematurely terminated due to the negative impact of CAP on bacterial sensitivity.ConclusionsThe benefits of CAP in infants with mild to moderate IH were inconclusive. CAP conferred a high risk of resistant bacterial organisms when UTI occurs.