Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Stanford University School of Medicine, Stanford Children's Health, Stanford, CA, USA.
BMC Urol. 2023 Aug 8;23(1):133. doi: 10.1186/s12894-023-01301-x.
The use of postoperative prophylactic antibiotics in pediatric upper urinary tract reconstruction remains controversial. In this study, we examined whether low dose antibiotics administered following pediatric pyeloplasty reduce the incidence of febrile urinary tract infections at our institution. As a secondary outcome, in those patients with infection, additional analysis was performed to better quantify which patient population benefits the most from low dose prophylactic antibiotics.
Institutional review board approval (IRB) was obtained. All methods were carried out in accordance with relevant guidelines and regulations. A retrospective study was performed in patients who underwent pyeloplasty (2011-2017) at our institution. Surgical approach (laparoscopic versus robotic assisted versus open, with or without internal JJ ureteral stent) were based on surgeon preference. Patients of 8 fellowship trained pediatric urologists were included in the study period. Patients with prior history of urologic interventions or other congenital genitourinary tract abnormalities were excluded. Demographics (age, gender, ethnicity, insurance status), prior history of culture proven urinary tract infection, surgical details (administration of perioperative antibiotics), and postoperative outcomes including; 1) re-admission 30 days post-surgery, 2) any urine cultures collected due to suspected urinary tract infection.
A total of 209 patients (149 boys, 60 girls) met our inclusion criteria with 55/209 (26%) receiving postoperative prophylactic antibiotics. The average age was 6 years (range: 2 months-18 years). Indwelling ureteral stent was used in 176 (84%) patients. Eleven patients (5%) had a culture-proven urinary tract infection within 30-days postoperatively. No significant differences were seen in postoperative complications or incidence of urinary tract infection when comparing surgical approaches, +/- ureteral stent, or the use of antibiotics. Secondary analysis noted statistically significant increase in post-operative urinary tract infection in younger children (2.8 v. 6.2 years, p = 0.02), those patients who had a positive preoperative urine culture (8/11, p = 0.01) and those with public health insurance (p = 0.038).
The incidence of postoperative urinary tract infection following pyeloplasty in our cohort was relatively low. There was a higher incidence of urinary tract infection in patients less than 3 years old. The use of antibiotics in patients post pyeloplasty did not appear to affect the incidence of post-operative urinary tract infection, however, they may have a role in children who have not yet potty trained and in patients with positive preoperative urine culture.
在小儿上尿路重建术中使用术后预防性抗生素仍存在争议。在本研究中，我们研究了在我院施行小儿肾盂成形术后使用低剂量抗生素是否可以降低发热性尿路感染的发生率。作为次要结果，在发生感染的患者中，进行了进一步分析，以更好地量化哪些患者群体从低剂量预防性抗生素中获益最大。
获得机构审查委员会（IRB）的批准。所有方法均按照相关指南和规定进行。对我院施行的肾盂成形术（2011-2017 年）患者进行回顾性研究。手术方法（腹腔镜、机器人辅助、开放，是否使用内置 JJ 输尿管支架）根据外科医生的偏好而定。在研究期间，纳入了 8 位小儿泌尿科研究员的患者。排除了有泌尿系统干预史或其他先天性泌尿生殖系统异常的患者。纳入标准为：人口统计学资料（年龄、性别、种族、保险状况）、既往有经培养证实的尿路感染病史、手术细节（围手术期抗生素的使用）和术后结果，包括：1）术后 30 天内再次入院，2）因疑似尿路感染而采集的任何尿液培养。
共有 209 名患者（149 名男孩，60 名女孩）符合纳入标准，其中 55/209（26%）接受了术后预防性抗生素治疗。平均年龄为 6 岁（范围：2 个月-18 岁）。176 名患者（84%）留置了输尿管支架。11 名患者（5%）术后 30 天内发生经培养证实的尿路感染。比较手术方法、+/-输尿管支架或抗生素使用时，术后并发症或尿路感染的发生率无显著差异。二次分析显示，年龄较小的儿童（2.8 岁与 6.2 岁，p=0.02）、术前尿液培养阳性的患者（8/11，p=0.01）和接受公共健康保险的患者（p=0.038）术后尿路感染发生率显著升高。
在本队列中，肾盂成形术后尿路感染的发生率相对较低。3 岁以下患者尿路感染发生率较高。肾盂成形术后使用抗生素似乎不会影响术后尿路感染的发生率，但在尚未开始如厕训练的儿童和术前尿液培养阳性的患者中可能有一定作用。
