Antibiotic prophylaxis for prevention of urinary tract infections in prenatal hydronephrosis: An updated systematic review

Abstract

Introduction: While continuous antibiotic prophylaxis (CAP) is currently recommended to prevent urinary tract infections (UTIs) in infants with prenatal hydronephrosis (HN), this recommendation is not evidence-based. The objective of this study was to systematically determine whether CAP reduces UTIs in the HN population. Methods: Applicable trials were identified through an electronic search of MEDLINE (1946MEDLINE ( -2015, EMBASE (1980EMBASE ( -2016, CINAHL (1982), and CENTRAL (1993 and through a hand search of American Urological Association (AUA) (2012)(2013)(2014)(2015) and European Society for Pediatric Urology (ESPU) (2012)(2013)(2014)(2015) abstracts, as well as reference lists of included trials. The search strategy was not limited by language or year of publication. Eligible studies compared CAP to no CAP in patients with antenatal HN, <2 years of age, and reported development of UTI and HN grades. Two independent reviewers performed title and abstract screening, full-text review, and quality appraisal. Results: Of 1518 citations screened, 11 were included, contributing 3909 patients for final analysis. Of these, four (36%) were considered high-quality when assessed by the Newcastle Ottawa Scale. Meta-analysis of the non-randomized trials (n=10) provided similar pooled UTI rates, regardless of CAP use: 9.9% (95% confidence interval [CI] 8.4-11.4%) for CAP and 7.5% (95% CI 6.4-8.6%) for no CAP. Conclusions: This systematic review and meta-analysis suggests there may be value in providing CAP to infants with high-grade HN; however, due to the very low-quality data from non-randomized studies, important clinical variables, such as circumcision status, were unable to be assessed.

Frequency of urinary tract infection in children with antenatal diagnosis of urinary tract dilatation

“…Data analysis showed that 58% of UTI (11 out of 19) occurred in patients with VUR. However, UTI occurred in only 3% of patients without VUR (8 out of 263), a lower frequency to that reported by the meta-analysis of Easterbrook et al 5. Furthermore, despite in our cohort there were no circumcised patients, the rate of UTI was not as high as that reported in previous studies 20 21…”

“…In the great part of cases, the prenatal finding of UTD is mostly transient and carries limited clinical significance. In some patients, it denotes the presence of an obstructive condition or of a vesicoureteral reflux (VUR) that may lead to an increased risk of UTI and renal damage 1 5. The aetiology of UTD is poorly predicted by prenatal US and is usually diagnosed in the postnatal setting with additional imaging.…”

Antenatally detected urinary tract dilatation: a 12–15-year follow-up

“…The frequency of UTI in children with UTD varies from approximately 3 to 34% depending on selection criteria [5,7,[19][20][21][22][23][24][25]. During the first 2 years of life, frequency of UTI was 9% in our cohort [13], which is close to the 13% frequency reported from neighboring Finland [24] and is not surprising given that the majority of our participants had mild UTD.…”

Canadian Urological Association/Pediatric Urologists of Canada guidelines on the investigation and management of antenatally detected hydronephrosis

“…The estimated number needed to treat was seven, meaning that a clinician would offer CAP to seven patients with high-grade HN in order to prevent one UTI (40). A more recent systematic review confirmed that there seems to be value in providing CAP to infants with high-grade HN (41).…”