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Variable UTI Rate in Isolated Hydronephrosis: Implications for Prophylactic Antibiotic Use

Poster #: 13
Session/Time: B
Author: Gwendolyn George
Mentor: Sarah Williamson, MD
Co-Investigator(s): 1. Matthew McCarron, EVMS MD Program 2. Miccah M Seaman, Division of Pediatric Urology, CHKD 3. Janelle A Fox, MD, Division of Pediatric Urology,CHKD 4. Carol Davis-Dao, Ph.D., Division of Pediatric Urology, Children's Hospital of Orange County, University of California, Irvine, Department of Urology 5. Jasilyn A Wray-Jordan, Division of Pediatric Urology, CHKD
Research Type: Clinical Research

Abstract

Introduction: Hydronephrosis is the abnormal dilation of the renal pelvis and calyces. Urinary tract infections (UTI) are the most common complication of hydronephrosis, resulting from urine stasis and collection allowing for bacterial growth. Continuous antibiotic prophylaxis (CAP) can be recommended for children with hydronephrosis, although there is limited data to support this intervention.

Methods: Patients with prenatal hydronephrosis confirmed via postnatal ultrasound with a documented Society of Fetal Urology (SFU) grade ≥ 1 who were enrolled in the multi-institutional Society for Pediatric Urology Prenatal Hydronephrosis Database were included for analysis. Exclusion criteria were confirmed vesicoureteral reflux, megaureter, duplicated collecting systems, solitary kidney, ureterocele, multicystic dysplastic kidney, neurogenic bladder, and other kidney and ureteral anomalies. Male patients with missing circumcision status were also removed from the analysis.

Results: There were 1672 patients who met the inclusion criteria for analysis. The overall UTI rate was 5.2% (87/1672). Most patients had a single UTI during the study period (n=73). UTI frequency was 8.8% (34/386) in females compared to 4.1% (53/1286) in males. Among males, UTI was more common in uncircumcised patients, occurring in 6.4% (39/611) compared to 2.1% of circumcised males (14/675). UTI occurred in 8.6% (56/651) of patients with high grade hydronephrosis (defined as SFU grades 3 or 4), compared to 3.0% (31/1021) in low grade hydronephrosis (SFU grades 1 or 2). Females with high grade hydronephrosis had the highest rates of UTI at 15% (24/157).

Conclusion: The UTI rates in patients with hydronephrosis correlate with sex, circumcision status in males, and the severity of hydronephrosis. While the overall UTI rate in isolated hydronephrosis is only 5.2%, patients with one or more risk factors can have a much higher UTI rate. CAP use is an important consideration for clinical management in high-risk groups, such as females with grades 3 and 4 hydronephrosis.