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Original research
Frequency of urinary tract infection in children with antenatal diagnosis of urinary tract dilatation
  1. Marco Pennesi1,
  2. Stefano Amoroso2,
  3. Giulia Bassanese3,
  4. Stefano Pintaldi2,
  5. Giulia Giacomini2,
  6. Egidio Barbi1,2
  1. 1 Department of Pediatrics, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
  2. 2 Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
  3. 3 Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
  1. Correspondence to Dr Stefano Amoroso, Universita degli Studi di Trieste, Trieste 34127, Italy; stefanoamoroso1234{at}gmail.com

Abstract

Background Neonates with congenital urinary tract dilatation (UTD) may have an increased risk of urinary tract infections (UTI). At present, the management of these patients is controversial and the utility of continuous antibiotic prophylaxis (CAP) remains uncertain as the literature presents contradicting evidence. The aim of this observational study was to assess UTI occurrence in children with prenatal diagnosis of urinary collecting system dilatation without antibiotic prophylaxis.

Methods Between June 2012 and August 2016, we evaluated the incidence of UTI and the clinical and ultrasonography evolution in 407 children with a prenatally diagnosed UTD. All subjects underwent two prenatal ultrasounds scans (USs) at 20 weeks and 30 weeks of gestation and within 1 month of birth. Patients with a confirmed diagnosis of UTD underwent US follow-up at 6, 12 and 24 months of life. According to the UTD classification system stratify risk, after birth UTD were classified into three groups: UTD-P1 (low risk group), UTD-P2 (intermediate risk group), and UTD-P3 (high risk group). Voiding cystourethrogram was performed in all patients who presented a UTI and in those with UTD-P3. No patient underwent CAP.

Results Postnatal US confirmed UTD in 278 out of 428 patients with the following rates: UTD-P1 (126), UTD-P2 (95) and UTD-P3 (57). During postnatal follow-up, 6.83% patients presented a UTI (19 out of 278). Eleven out of 19 had vesicoureteral reflux (VUR), and other four were diagnosed with obstructive uropathy and underwent surgical correction. Five patients presented a UTI reinfection.

Conclusion The occurrence of UTI in patients with urinary collecting system dilatation was low. The recent literature reports an increased selection of multirestistant germs in patients with VUR exposed to CAP. This study constitutes a strong hint that routine continuous antibiotic prophylaxis could be avoided in patients with UTD.

  • Nephrology
  • Epidemiology
  • Urology
  • Infectious Diseases

https://doi.org/10.1136/archdischild-2019-317637

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    Footnotes

    • Contributors MP conceptualised and designed the study, drafted the initial manuscript and approved the final manuscript as submitted. GB, SP and SA carried out the initial analyses, reviewed and revised the manuscript and approved the final manuscript as submitted. MP and EB critically reviewed the manuscript and approved the final manuscript as submitted.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the internal review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.