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Continuous Antibiotic Prophylaxis Reduces The Incidence Of UTI In A Specific Subset Of Children With Antenatal Hydronephrosis And Ureteral Dilation
Daniel B. Herz, MD1, Paul A. Merguerian, MD2, Leslie T. McQuiston, MD3.
1Nationwide Children's Hospital, Colmbus, OH, USA, 2Seattle Children's Hospital, Seattle, WA, USA, 3Dell Children's Hospital, Austin, TX, USA.

BACKGROUND: The efficacy and utility of continuous antibiotic prophylaxis (CAP) in children born with congenital antenatal hydronephrosis (ANH) has come into question in recent years. The literature has both supportive and contradictory evidence. The growing trend not to place children with ANH on CAP has created inconsistent clinical usage based on individual case characteristics. Our goal was to compare perinatal and infant characteristics between those children who were maintained on CAP to those that were not to try to determine predisposing risk factors to UTI that might make CAP indicated.
METHODS: All electronic medical records (EMR) of children referred to our institution for congenital ANH over a period from 2001 to 2011 were examined. We excluded those referred for UTI who also had a history of congenital ANH. We also excluded those with incomplete records, or follow-up less than 6 months. Children were divided into 2 groups: Those maintained on CAP (YCAP) and those not maintained on CAP (NCAP). Our primary endpoint was UTI. Follow-up was between 12-24 months. Demographic as well as prenatal and postnatal clinical data were recorded. Statistical analysis and computation was performed using STATA Version 11.1.
RESULTS: A total of 507 children fit the inclusion criteria. 298 (59%) were male and 209 (41%) were female. Average age at the time of referral was 2.2 weeks (range 0-17 weeks). 213 (42%) were seen for prenatal counseling by a Pediatric Urology staff member. 378 (75%) children were maintained on CAP and 129 (25%) were not on CAP at the time of referral and evaluation. Mean age at the time of referral (YCAP=2.9 and NCAP=5.6) was significant (p=0.024). Overall the incidence of UTI during the follow-up period was 17%. Although there was a small difference in the incidence of UTI between the YCAP and NCAP groups, this was NOT significant (YCAP=14% and NCAP 21%, p=0.067). The percentage of high grade vesicoureteral reflux (VUR), high SFU grade hydronephrosis, oligohydramnios, perinatal respiratory complications, circumcision status, duplication anomalies, multicystic dysplasia, posterior urethral valves, and ureteral dilation did not differ between the 2 groups. However, the incidence of UTI was significantly lower in children with ureteral dilation (ultrasound diameter > 1.2 cm) who were maintained on CAP (p<0.001). Those children NOT maintained on CAP had a 4.7 [OR=4.7: CI=2.9-6.3] fold increased risk of UTI compared to those maintained on CAP in the follow-up period.
CONCLUSIONS: The presence of ureteral dilation was an independent risk factor for the development of UTI in children with congenital ANH. Continuous antibiotic prophylaxis lowered this risk by more than 5 fold. Therefore CAP may have a significant role in reducing the risk UTI in children with ANH and ureteral dilation, but otherwise seems unnecessary.


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