Department of Urology, Boston Children's Hospital, Boston, MA, USA.
Department of Urology, Boston Children's Hospital, Boston, MA, USA.
J Pediatr Urol. 2018 Dec;14(6):539.e1-539.e6. doi: 10.1016/j.jpurol.2018.04.022. Epub 2018 May 29.
There is a lack of consensus regarding the use of continuous antibiotic prophylaxis (CAP) during the interval between birth and initial postnatal imaging in infants with a history of antenatal urinary tract dilation (AUTD).
To determine the incidence of urinary tract infection (UTI), and the association between CAP use and UTI during the interval between birth and the first postnatal renal ultrasound (RUS) in infants with AUTD.
A single-institution, retrospective cohort study of newborns with a history of AUTD. Infants undergoing RUS within 3 months of birth for an indication of 'hydronephrosis' between 2012 and 2014 were identified. A random sample of 500 infants was selected; six were excluded for concomitant congenital anomalies. Baseline patient (sex, race, insurance) and clinical characteristics (circumcision status, UTD risk score, receipt of CAP, UTI prior to RUS, age at UTI, and age at RUS) were collected via retrospective chart review. Descriptive statistics were calculated. To adjust for receipt of CAP, propensity score adjusted univariate logistic regression for UTI based on CAP status was performed.
Among the 494 infants with AUTD, 157 (32%) received CAP. Infants with normal/low-risk UTD scores were less likely to receive CAP than those with medium/high-risk UTD (23% vs 77%; P < 0.001). There was no difference in CAP based on sex, insurance, or circumcision status (among 260/365 males with known circumcision status). Overall, seven infants (1.4%) developed UTI prior to imaging: six (1.8%) without CAP vs one (0.64%) with CAP (P = 0.44). The median age at UTI was 59 days (range 2-84); among those with UTI, initial imaging occurred significantly later (66 vs 28 days; P = 0.001). The propensity score adjusted odds of developing UTI with CAP (vs without) was 0.93 (95% CI 0.10-8.32; P = 0.95). The Summary Figure describes the infants with UTI.
The incidence of UTI prior to initial neonatal imaging in newborns with AUTD was low. Use of CAP was not associated with UTI incidence after adjusting for UTD severity. Routine use of CAP in newborns with AUTD prior to initial imaging may be of limited benefit in most patients.
在有产前尿路扩张（AUTD）病史的婴儿中，对于出生与首次产后影像学检查之间的时间间隔内是否使用连续抗生素预防（CAP），目前尚无共识。
确定在有 AUTD 病史的婴儿中，CAP 的使用与出生至首次产后肾脏超声（RUS）检查期间发生尿路感染（UTI）之间的相关性。
对有 AUTD 病史的新生儿进行单中心、回顾性队列研究。在 2012 年至 2014 年期间，我们确定了在出生后 3 个月内因“肾积水”指征而行 RUS 的新生儿。随机抽取 500 名婴儿，因合并先天性异常而排除 6 名。通过回顾性图表审查收集基线患者（性别、种族、保险）和临床特征（割礼状况、UTD 风险评分、接受 CAP、RUS 前 UTI、UTI 年龄和 RUS 年龄）。计算描述性统计数据。为了调整 CAP 的使用，根据 CAP 状态对 UTI 进行了基于倾向评分调整的单变量逻辑回归分析。
在 494 名 AUTD 婴儿中，157 名（32%）接受了 CAP。UTD 评分正常/低危的婴儿比中/高危 UTD 评分的婴儿更不可能接受 CAP（23%比 77%；P<0.001）。基于性别、保险或割礼状态，CAP 没有差异（在已知割礼状态的 260/365 名男性中）。总体而言，有 7 名婴儿（1.4%）在影像学检查前发生 UTI：6 名（1.8%）无 CAP 与 1 名（0.64%）有 CAP（P=0.44）。UTI 的中位年龄为 59 天（范围 2-84）；在有 UTI 的婴儿中，首次影像学检查的时间明显延迟（66 天与 28 天；P=0.001）。在调整 UTD 严重程度后，有 CAP（与无 CAP）发生 UTI 的可能性的优势比为 0.93（95%CI 0.10-8.32；P=0.95）。摘要图描述了有 UTI 的婴儿。
AUTD 新生儿在首次新生儿影像学检查前发生 UTI 的发生率较低。在调整 UTD 严重程度后，CAP 的使用与 UTI 发生率无关。在首次影像学检查前，对有 AUTD 病史的新生儿常规使用 CAP 可能对大多数患者的益处有限。
