scholarly journals Installation or exchange of double-J ureteral stent is a risk factor of febrile urinary tract infection in a compromised host

2019 ◽  
Author(s):  
Hiroyuki Kitano ◽  
Jun Teishima ◽  
Hiroki Ohge ◽  
Akio Matsubara
Keyword(s):  
Risk Factor ◽  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Prophylactic Antibiotic ◽  
Ureteral Stent ◽  
Compromised Host ◽  
Febrile Uti ◽  
Prophylactic Antibiotic Therapy ◽  
Febrile Urinary Tract Infections ◽  
Tract Infections

Abstract Background : To study the predictors of febrile urinary tract infections (febrile UTI) after the placement of Indwelling double-J ureteral stent (DJS), and effective prophylactic antimicrobial agent. Methods : Installation or exchange of 298 double-J stents (DJS) ( 66 men and 232 women, median age 67 years, range 42～86) were examined. 258 patients had been given prophylactic antibiotic therapy after the placement of stents, 40 patients with no prophylactic antibiotic therapy. Results : 14 patients (4.2%) had febrile UTI after the placement of the stent. The pathogens was identified from the pelvic urine culture of 9 patients with febrile UTI. Enterococcus faecalis was the most common pathogen, it accounted for 25.0% of all pathogens. Compromised host was potential risk factors for the febrile UTI in patients with DJS. 1.1% of patients who received with fluoroquinolones or 4.7% of patients with cephalosporin developed a febrile UTI. Conclusions : Indwelling DJS is a risk factor of febrile UTI in a compromised host, fluoroquinolones may be effective for preventing febrile UTI after placement of DJS.

scholarly journals Is There a Role for Prophylactic Antibiotics Post Pediatric Pyeloplasty?

2020 ◽  
Author(s):  
Kunj Sheth ◽  
Kathleen Puttmann ◽  
Paige Nichols ◽  
Jordon C King ◽  
Huirong Zhu ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urine Culture ◽  
Significant Risk ◽  
Prophylactic Antibiotics ◽  
Ureteral Stent ◽  
Secondary Outcome ◽  
Prior History ◽  
Febrile Uti ◽  
History Of ◽  
Tract Infections

Abstract Background: The use of postoperative prophylactic antibiotics in pediatric upper urinary tract reconstruction remains controversial. In this study, we elected to examine if prophylactic antibiotics post pediatric dismember pyeloplasty reduce the incidence of clinically symptomatic urinary tract infections (UTIs) in our institution. As a secondary outcome, we also examine which patient population benefits the most from low dose prophylactic antibiotics.Methods: Institutional review board approval (IRB) was obtained. A retrospective study was performed in patients who underwent dismember pyeloplasty (2011-2017) at our institution. Patients with prior history of urologic interventions or other abnormalities of the genitourinary tract were excluded. Demographics (age, gender, ethnicity, insurance status), prior history of culture proven UTIs, surgical details (administration of perioperative antibiotics), and postoperative outcomes, including any readmission 30 days post repair, any urine samples, and culture results were collected.Results: 209 patients (149 boys, 60 girls) met our inclusion criteria. The average age was 6 years (range: 2 months-18 years). 160 patients (77%) underwent robotic-assisted pyeloplasty. Thirty-one patients underwent open repair (15%). 176 (84%) had an indwelling ureteral stent. Eleven patients (5%) had a culture-proven febrile UTI within 30-days postoperatively. No significant differences were seen in postoperative complications or incidence of UTIs when comparing surgical approaches, ureteral stent, or the use of prophylactic post-operative antibiotics. Secondary review of patients with post-operative febrile UTIs noted younger age (2.8 v. 6.2 years, p = 0.02) and positive intraoperative urine culture (p = 0.01) as significant risk factors. Conclusion: The incidence of postoperative UTIs in our cohort is relatively low. There is a higher incidence of febrile UTIs in patients less than 3 years old and those with positive intraoperative urine culture. The use of prophylactic antibiotics in patients post dismember pyeloplasty did not appear to affect the incidence of febrile culture proven UTIs, however, might be important in younger patients pre potty training.

scholarly journals Prophylactic Antibiotics After Stented, Distal Hypospadias Repair: Randomized Pilot Study

2018 ◽  
Vol 5 ◽  
pp. 2333794X1877007 ◽  
Author(s):  
Stephen Canon ◽  
Mary K. Marquette ◽  
Adam Crane ◽  
Ashay Patel ◽  
Ismael Zamilpa ◽  
...  
Keyword(s):  
Pilot Study ◽  
Antibiotic Therapy ◽  
Prophylactic Antibiotic ◽  
Hypospadias Repair ◽  
Prophylactic Antibiotic Therapy ◽  
Distal Hypospadias ◽  
Group 2 ◽  
Tract Infections ◽  
The Impact ◽  
Group 1

The usage of prophylactic oral antibiotics following distal hypospadias repair with stenting has been recently challenged. This study evaluated the incidence of symptomatic urinary tract infections (UTIs) following stented, distal hypospadias repair and the impact of prophylactic antibiotic therapy. Subjects 0 to 5 years of age with distal hypospadias were randomized to either Group 1 (antibiotics) or Group 2 (no prophylactic therapy). Urinalysis/urine culture was obtained intraoperatively with no preoperative antibiotics given. Phone interviews at 1 month and 3 months after surgery were done. Forty-eight patients were successfully randomized to either Group 1 (24) or Group 2 (24). The incidence of symptomatic UTI in this pilot study is low, and prophylactic antibiotic therapy does not appear to lower the incidence of symptomatic UTI. A larger, randomized, multicenter trial is needed to determine whether antibiotic prophylaxis reduces the risk of symptomatic UTIs following stented, distal hypospadias repair.

scholarly journals The Diagnosis and Treatment of Vesicoureteral Reflux: An Update

2015 ◽  
Vol 8 (1) ◽  
pp. 96-103 ◽  
Author(s):  
Adam Rensing ◽  
Paul Austin
Keyword(s):  
Urinary Tract ◽  
Vesicoureteral Reflux ◽  
Renal Scarring ◽  
Reflux Nephropathy ◽  
Bowel Dysfunction ◽  
Alternative Approach ◽  
Febrile Uti ◽  
Febrile Urinary Tract Infections ◽  
Tract Infections ◽  
Pediatric Providers

Vesicoureteral reflux [VUR] remains a common problem seen by pediatric providers. Despite a great deal of research, the debate regarding how to screen and treat patients reremains tense and controversial. This review seeks to summarize the management of VUR with emphasis on recent published findings in the literature and how they contribute to this debate. The goals of managing VUR include preventing future febrile urinary tract infections [FUTI], renal scarring, reflux nephropathy and hypertension. The topdown approach with upper tract imaging and selective vesicocystourethrogram [VCUG] is an emerging alternative approach in the evaluation of children after their first FUTI. The elimination of bladder and bowel dysfunction [BBD] is an important management strategy to prevent further FUTIs, regardless of treatment choice. Antibiotic prophylaxis is a safe and effective modality to sterilize the urinary tract. Endoscopic treatment of VUR is an attractive modality in select patients, although some concerns remain regarding its effectiveness and durability as compared to to the gold standard of open or laparoscopic ureteroneocystostomy. Lastly, further research is required to determine the most effective algorithm to evaluate the pediatric patient after the first febrile UTI.

Fever duration during treated urinary tract infections and development of permanent renal lesions

2018 ◽  
Vol 104 (5) ◽  
pp. 466-470 ◽  
Author(s):  
Kyriaki Karavanaki ◽  
Athina Maria Koufadaki ◽  
Alexandra Soldatou ◽  
Charalambos Tsentidis ◽  
Maria Sourani ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Treatment Initiation ◽  
Older Age ◽  
First Episode ◽  
Renal Lesion ◽  
Renal Lesions ◽  
Febrile Uti ◽  
Febrile Urinary Tract Infections ◽  
Tract Infections

ObjectiveTo assess the effect of the duration of fever after the initiation of treatment (FAT) of febrile urinary tract infections (UTI) on the development of permanent renal lesions based on dimercaptosuccinic acid (DMSA) scintigraphy findings. To evaluate the FAT contribution to permanent renal lesion formation in relation to fever before treatment initiation (FBT), the presence of vesicourinary reflux (VUR), age and severity of infection.MethodsThe inpatient records of 148 children (median age: 2.4 months (11 days to 24 months)) with a first episode of UTI during a 3-year period were analysed. DMSA findings, and clinical and laboratory parameters were evaluated.ResultsAmong the study population, 34/148 (22.97%) children had permanent renal lesions on the DMSA scan 6 months after a single episode of UTI. Twenty-three children (15.5%) had mild, 10 (6.7%) had moderate and 1 (0.6%) child had severe lesions on the DMSA. FAT prolongation >/48 hours was associated with older age (p=0.01) and increased absolute neutrophil count (p=0.042). The likelihood of lesions was significantly increased when FAT was ≥48 hours (R2=0.043, p=0.021). On multiple regression analysis, with the addition of FBT>/72 hours (0.022), the presence of VUR (p<0.001), C-reactive protein (p=0.027) and age (p=0.031), the effect of FAT on lesion development disappeared (p=0.15).ConclusionsProlongation of FAT≥48 hours of febrile UTI in children <2 years significantly contributes to the development of permanent renal lesions. However, delay in treatment initiation >/72 hours, the presence of VUR, older age and infection severity seem to be more significant predictors of the development of renal lesions.

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