Nonrefluxing Neonatal Hydronephrosis and the Risk of Urinary Tract Infection

Lee, Joo Hoon; Choi, Hyung Soon; Kim, Jeong Kon; Won, Hye‐Sung; Kim, Kun Suk; Moon, Dae Hyuk; Cho, Kyong-Sik; Park, Young-Seo

doi:10.1016/j.juro.2007.11.090

Cited by 89 publications

(77 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As has been described in previous reports, [8] our study found that E. coli, pseudomonas aeruginosa, and klebsiella pneumoniae were the most common organisms cultured from urine. No patient with a urine culture positive for E. coli had a history of nephrostomy or pyeloplasty, unlike patients with urine cultures positive for other organisms.…”

Section: Discussionsupporting

confidence: 87%

Which Patients Should be Administrated Prophylactic Antibacterial Agents? A Study of Bacteriuria or Funguria by Urine Culture Taken From the Renal Pelvis in Children with Ureteropelvic Junction Obstruction

Deng¹,

Zhang²,

Li³

et al. 2011

OJU

View full text Add to dashboard Cite

Objective: To detect bacteriuria or funguria by urine culture taken from the renal pelvis directly before Anderson-Hynes pyeloplasty. Methods: 290 patients who underwent Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction (UPJO) were included in a retrospective analysis. Urine was obtained directly before the renal pelvis was opened, and was carried to the laboratory for bacterial culture. Clinical features were analyzed to evaluate risk factors for bacteriuria or funguria by comparing patients whose urine yielded positive cultures to those whose urine cultures were negative for bacteria or yeast. Results: Eighteen patients (6.2%) had positive urine cultures, including six cultures positive for Escherichia coli (E. coli), four for Pseudomonas aeruginosa, three for klebsiella pneumoniae, one for maltophilia monad, one for Enterococcus faecium, one for Candida albicans, one for Candida parapsilosis, and one for yeast not otherwise specified. Bacteriuria or funguria was significantly correlated with four clinical features: fever, urinary urgency, and history of nephrostomy or pyeloplasty. Conclusions: Bacteriuria or funguria was less common in children with UPJO, and the majority of organisms were identified as Escherichia coli, Pseudomonas aeruginosa, or Klebsiella pneumoniae. Prophylactic antibacterial agents were probably necessary in those patients who had signs of urinary tract infection (UTI), or history of nephrostomy or pyeloplasty.

show abstract

Section: Discussionsupporting

confidence: 87%

Which Patients Should be Administrated Prophylactic Antibacterial Agents? A Study of Bacteriuria or Funguria by Urine Culture Taken From the Renal Pelvis in Children with Ureteropelvic Junction Obstruction

Deng¹,

Zhang²,

Li³

et al. 2011

OJU

View full text Add to dashboard Cite

show abstract

“…The rationale for antibiotic prophylaxis in children with a history of prenatally detected uropathies includes prevention of UTIs, because infants with hydronephrosis are at increased risk (31,32). UTI rates seem to be as high as 40% in children with severe hydronephrosis (33). In a previous study, we estimated a cumulative incidence of UTIs as 39% and 11% at 36 months of age for severe and mild RPD, respectively (27).…”

Section: Discussionmentioning

confidence: 99%

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Quirino

Diniz

Bouzada

et al. 2012

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies.Design, setting, participants, & measurements In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest.Results Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P,0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P,0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P,0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P,0.001).Conclusions In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.

show abstract

“…Song et al [19] reported that 30% of 75 infants with grades III and IV hydronephrosis secondary to UPJO developed UTI when followed without antibiotic prophylaxis; the authors concluded that children with severe hydronephrosis should receive antibiotic prophylaxis. Lee et al [20] declared that antibiotic prophylaxis might be beneficial in obstructive hydronephrosis based on an observation that 39% of their patients with obstructive uropathy had UTI.…”

Section: Discussionmentioning

confidence: 99%

Probability of urinary tract infection in infants with ureteropelvic junction obstruction: is antibacterial prophylaxis really needed?

et al. 2011

View full text Add to dashboard Cite

In infants with ureteropelvic junction obstruction (UPJO), the risk of urinary tract infection (UTI) is unknown, and there is a lack of prospective studies showing definitive evidence regarding the benefits and necessity of antibiotic prophylaxis. The aim of this study was to assess the risk of UTI in infants with UPJO and to determine whether the risk varies according to the degree of hydronephrosis. Infants with hydronephrosis detected prenatally or within the postnatal 28th day and who had no previous history of UTI were followed prospectively without antibacterial prophylaxis. Imaging studies were performed according to our Pediatric Uro-Nephrology Study Group protocol. Dimercaptosuccinate (DMSA) scintigraphy was performed in all infants at the end of 1 year of follow-up. Eighty-four infants (56 boys, 28 girls) were included in the study. The distribution of patients in each hydronephrosis grading group was incidentally similar. Within a median follow-up period of 18 (12-24) months, none of the patients had UTI. Furthermore, no pyelonephritic scar was found on DMSA scans in any patient. We conclude that prophylactic antibiotic usage is not indicated in infants with UPJO, regardless of the severity of hydronephrosis, as the risk of UTI is minimal in this population.

show abstract

Nonrefluxing Neonatal Hydronephrosis and the Risk of Urinary Tract Infection

Abstract: Neonates with obstructive uropathy, severe hydronephrosis or hydroureteronephrosis have increased risk of urinary tract infection even without reflux, and antibiotic prophylaxis may be recommended.

Cited by 89 publications

References 19 publications

Which Patients Should be Administrated Prophylactic Antibacterial Agents? A Study of Bacteriuria or Funguria by Urine Culture Taken From the Renal Pelvis in Children with Ureteropelvic Junction Obstruction

Which Patients Should be Administrated Prophylactic Antibacterial Agents? A Study of Bacteriuria or Funguria by Urine Culture Taken From the Renal Pelvis in Children with Ureteropelvic Junction Obstruction

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Probability of urinary tract infection in infants with ureteropelvic junction obstruction: is antibacterial prophylaxis really needed?

Contact Info

Product

Resources

About