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Pyeloplasty with ureteral stent placement in children: Do prophylactic antibiotics serve a purpose?

      Summary

      Objectives

      Ureteral stents are commonly used during pyeloplasty to ensure drainage and anastomotic healing. Antibiotic prophylaxis is often used due to concerns for urinary tract infection (UTI). Although many surgeons prescribe prophylactic antibiotics following pyeloplasty, practices vary widely due to lack of clear evidence-based guidelines. We hypothesize that the rate of stent UTI does not significantly vary between children who receive antibiotics and those who do not.

      Methods

      We reviewed the medical records of 741 patients undergoing pyeloplasty between January 2010 and July 2018 across seven institutions. Exclusion criteria were: age older than 22 years, no stent placed, externalized stents used, and incomplete records. Surgical approach, age, antibiotic use, stent duration, Foley duration, and urine culture results were recorded. Patients were categorized into two groups, those younger than four years of age and those four years and older as proxy for likely diaper use. Univariate logistic regression was conducted to identify variables associated with UTI. Multivariable backward stepwise logistic regression was used to identify the best model with Akaike information criterion as model selection criteria. The selected model was used to calculate odds ratios and 95% confidence intervals summarizing the association between prophylactic antibiotics and stent UTI while controlling for age, gender, and intra-operative urine cultures.

      Results

      672 patients were included; 338 received antibiotic prophylaxis and 334 did not. These groups differed in mean age (3.91 vs. 6.91 years, P < .001), mean stent duration (38.5 vs. 35.32 days, P < .001), and surgical approach (53.25% vs. 32.04% open vs. laparoscopic, P < .001). The incidence of stent UTI was low overall (7.59%) and similar in both groups: 31/338 (9.17%) in the prophylaxis group and 20/334 (5.99%) in the non-prophylaxis group (P = .119). Although female gender, likely diaper use, and positive intra-operative urine culture were each associated with significantly higher odds of stent UTI, prophylactic antibiotic use was not associated with significant reduction in stent UTI in any of these groups. Surgical approach, stent duration, and Foley duration were not associated with stent UTI.

      Conclusion

      Summary figure
      Graphical AbstractMultivariate Logistic Regression Following Backward Elimination Protocol.

      Keywords

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      Linked Article

      • Commentary to pyeloplasty with ureteral stent placement in children: Do prophylactic antibiotics serve a purpose?
        Journal of Pediatric UrologyVol. 18Issue 6
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          In this article the rate of UTI in children given prophylactic antibiotics after a stented pyeloplasty is compared to those who were stented and did not receive prophylaxis. The authors show through a large multi-center study that prophylactic antibiotics did not decrease stent associated UTI. This paper is timely as clinicians are acutely aware of the need for increased antibiotic stewardship. In addition, by decreasing the use of antibacterial prophylaxis surgeons can positively impact heath care costs.
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