Easterbrook Bethany, Capolicchio John-Paul, Braga Luis H
McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Division of Urology, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
Can Urol Assoc J. 2017 Jan-Feb;11(1-2Suppl1):S3-S11. doi: 10.5489/cuaj.4384.
While continuous antibiotic prophylaxis (CAP) is currently recommended to prevent urinary tract infections (UTIs) in infants with prenatal hydronephrosis (HN), this recommendation is not evidence-based. The objective of this study was to systematically determine whether CAP reduces UTIs in the HN population.
Applicable trials were identified through an electronic search of MEDLINE (1946-2015), EMBASE (1980-2016), CINAHL (1982-2016), and CENTRAL (1993-2016) and through a hand search of American Urological Association (AUA) (2012-2015) and European Society for Pediatric Urology (ESPU) (2012-2015) abstracts, as well as reference lists of included trials. The search strategy was not limited by language or year of publication. Eligible studies compared CAP to no CAP in patients with antenatal HN, <2 years of age, and reported development of UTI and HN grades. Two independent reviewers performed title and abstract screening, full-text review, and quality appraisal.
Of 1518 citations screened, 11 were included, contributing 3909 patients for final analysis. Of these, four (36%) were considered high-quality when assessed by the Newcastle Ottawa Scale. Meta-analysis of the non-randomized trials (n=10) provided similar pooled UTI rates, regardless of CAP use: 9.9% (95% confidence interval [CI] 8.4-11.4%) for CAP and 7.5% (95% CI 6.4-8.6%) for no CAP.
This systematic review and meta-analysis suggests there may be value in providing CAP to infants with high-grade HN; however, due to the very low-quality data from non-randomized studies, important clinical variables, such as circumcision status, were unable to be assessed.
虽然目前推荐采用持续抗生素预防（CAP）来预防产前肾积水（HN）婴儿的尿路感染（UTI），但这一推荐并非基于证据。本研究的目的是系统地确定CAP是否能降低HN人群中的UTI发生率。
通过对MEDLINE（1946 - 2015年）、EMBASE（1980 - 2016年）、CINAHL（1982 - 2016年）和CENTRAL（1993 - 2016年）进行电子检索，并通过手工检索美国泌尿外科学会（AUA）（2012 - 2015年）和欧洲小儿泌尿外科学会（ESPU）（2012 - 2015年）的摘要以及纳入试验的参考文献列表来识别适用的试验。检索策略不受语言或出版年份限制。符合条件的研究比较了产前HN、年龄小于2岁的患者中CAP与不进行CAP的情况，并报告了UTI的发生情况和HN分级。两名独立评审员进行标题和摘要筛选、全文审查及质量评估。
在筛选的1518条引用中，纳入了11项研究，共3909例患者用于最终分析。其中，根据纽卡斯尔渥太华量表评估，4项（36%）被认为是高质量研究。对非随机试验（n = 10）的荟萃分析显示，无论是否使用CAP，合并的UTI发生率相似：使用CAP的为9.9%（95%置信区间[CI] 8.4 - 11.4%），不使用CAP的为7.5%（95% CI 6.4 - 8.6%）。
这项系统评价和荟萃分析表明，对重度HN婴儿提供CAP可能有价值；然而，由于非随机研究的数据质量非常低，无法评估诸如包皮环切状态等重要临床变量。
