Evaluating the Necessity of Antibiotics in the Treatment of Acute Epididymitis in Pediatric Patients

Cristoforo, Thomas A

doi:10.1097/pec.0000000000001018

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…According to the literature review by Cristoforo, more than 80% of patients with AE were treated antibiotics. [ 10 ] However, routine use of antibiotics in patients with AE is not recommended. Santillanes et al recommended withholding antibiotics until positive urine culture when the initial urinalysis is clean.…”

Section: Discussionmentioning

confidence: 99%

Different managements for prepubertal epididymitis based on a preexisting genitourinary anomaly diagnosis

2018

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There is no clear consensus regarding investigating for accompanying genitourinary anomalies (GUAs) in patients with prepubertal acute epididymitis (AE). Moreover, risk factors for the recurrence and the need for a surgical intervention have never been discussed. The purpose of this study was to evaluate the different clinical courses of prepubertal AE based on knowledge of preexisting GUAs. Between January 2005 and December 2014, AE was diagnosed in 189 pediatric patients <10 years old. Clinical characteristics and treatments were retrospectively analyzed. The median age at first AE was 64.3 months. A GUA was detected prior to the development of AE in 49 patients (known GUA group) including 34 with hypospadias. Among the other 140 patients (unknown GUA status group), six patients were diagnosed with a GUA after the first AE episode. In the known GUA group, 35 patients (71.4%) experienced recurrence and the only risk factor associated with recurrence was the presence of cystic dilated prostatic utricle (p = 0.013). In the unknown GUA status group, the risk factors for an existing GUA were being <1-year-old (p<0.001) and positive urine culture (p = 0.015). Only nine patients (6.4%) in this group experienced recurrence. Vasectomy was recommended for patients with recurrent AE with an accompanying GUA and performed in 19 patients (10.1%). Most GUAs are diagnosed prior to AE development. Clinicians should consider different treatment approaches based on whether the AE patient has been diagnosed with a GUA previously, because the clinical characteristics and the recurrence rate are significantly different.

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Section: Discussionmentioning

confidence: 99%

Different managements for prepubertal epididymitis based on a preexisting genitourinary anomaly diagnosis

2018

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“…Our results are comparable with other studies [ 16 , 22 , 24 ], which recommend to investigate children with a UTI by urinary tract and kidney US to search for a possible urogenital malformation for this reason. In patients without a previously documented malformation and a first episode of OE, urinary analysis and urinary culture should be performed for work-up, but an antibiotic treatment should not be introduced unless a UTI is suspected on the urinary analysis [ 19 , 25 ]. Given the low prevalence of UTI in these patients, blood test markers (white blood cell count and CRP) are not considered useful for work-up given their poor diagnostic performance.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is difficult to recommend specific investigation guidelines, such as urinary analysis, testicular and/or urinary tract and kidney ultrasonagraphy (US), or micturating cysto-urethrogram. This debate also impacts on guidelines for antibiotic treatment, which is either systematically recommended [14,17], or varies with the age of the patient [18,19], or with the association of a urinary tract infection (UTI) [2,4,19].…”

Section: Introductionmentioning

confidence: 99%

How useful is a complete urinary tract ultrasound in orchiepididymitis?

Aeschimann

Sanchez²,

Birraux

et al. 2022

PLoS ONE

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Orchiepididymitis (OE) is a frequent cause of pediatric emergency department attendance in boys presenting with acute scrotum. The etiology of most episodes of OE remains unclear and there is no consensus regarding the correlation between OE and underlying genitourinary malformations. Whether imaging evaluation should comprise complete urinary tract ultrasonography (US) or voiding cystography is a subject of debate. The aim of this retrospective, single-center study was to analyze i) the number/type of urinary tract malformations detected by US following a first episode of OE in boys with no previously known malformation and ii) the frequency of associated urinary tract infection (UTI). We reviewed the records of 495 boys <16 years presenting to our pediatric emergency department with acute scrotum between January 2012 and December 2017. Patients with incomplete radiological data were excluded. Of 119 boys with a radiologically-confirmed first episode of OE, 99 had a complete urinary tract US and were included in the study. No genitourinary malformation was detected (0%). Urinary cultures showed UTI in 3/98 (3.1%) patients. Mean age at presentation was 9.7 years (standard deviation, 3.9) with a three-peak incidence of OE at 10–13 years, 4–5 years, and during infancy. Conclusion: Complete urinary tract US does not appear to be useful during a first episode of OE in countries with an antenatal US screening rate similar to Switzerland. The very low UTI rate suggests that a urinalysis is sufficient to investigate a first episode of OE and antibiotics should be reserved for positive urinalysis only.

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“…In particular, a UA may be useful in pediatric patients with scrotal pain as a means to avoid antibiotics if the UA is negative (even in the setting of an ultrasound showing epididymitis-orchitis) as epididymitisorchitis is less commonly of bacterial origin in prepubertal children. [17][18][19] With that being said, despite recommendations to routinely order a UA for patients with acute scrotal pain, 2-4 many physicians already forgo this test. In our study, 69% had a urinalysis done, and in a different retrospective study assessing the evaluation of acute scrotal pain, only 48% of patients had a UA performed.…”

Section: Discussionmentioning

confidence: 99%

<p>Assessing the Utility of Ultrasound and Urinalysis for Patients with Possible Epididymo-Orchitis – A Retrospective Study</p>

Zitek

Ahmed

Lim

et al. 2020

OAEM

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Purpose: Many experts recommend ordering an ultrasound and a urinalysis on all patients with scrotal pain. While the ultrasound may help diagnose a number of potential causes of scrotal pain, the urinalysis primarily has value in assessing for epididymo-orchitis. This study sought to evaluate the utility of these diagnostic tests for patients who presented to the emergency department (ED) with acute scrotal pain and possible epididymo-orchitis. Patients and Methods: This was a single-center chart review of patients presenting to the ED with scrotal pain. Trained research assistants reviewed charts to obtain urinalysis and ultrasound results as well as diagnoses and treatments provided. Using the final diagnosis as a gold standard, the sensitivity and specificity of ultrasound and urinalysis were calculated for the diagnosis of epididymo-orchitis. Also, through a prespecified definition of "changed management," we estimated the percentage of cases in which a urinalysis changed management of patients with acute scrotal pain. Results: We identified 663 adult and pediatric patients who presented with scrotal pain during 2016. All patients had an ultrasound performed, and 458 (69.1%) had a urinalysis done. The sensitivity of urinalysis for epididymo-orchitis was 58.2% (95% CI 48.9% to 67.1%), and the specificity was 85.1% (95% CI 80.8% to 88.7%). For ultrasound, the sensitivity was 78.8% (95% CI 71.4% to 85.0%) and the specificity was 98.1% (95% CI 96.4% to 99.1%). In 24 of 458 cases (5.2% [95% CI 3.4% to 7.7%]) where a urinalysis was obtained, its results may have changed management of the patient. Conclusion: The diagnosis of patients who present to the ED with scrotal pain is primarily driven by the ultrasound results. While the urinalysis may occasionally provide some benefit in the evaluation of patients with suspected epididymo-orchitis, the reflexive ordering of a urinalysis in patients with scrotal pain may be unnecessary.

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Evaluating the Necessity of Antibiotics in the Treatment of Acute Epididymitis in Pediatric Patients

Cited by 8 publications

References 32 publications

Different managements for prepubertal epididymitis based on a preexisting genitourinary anomaly diagnosis

Different managements for prepubertal epididymitis based on a preexisting genitourinary anomaly diagnosis

How useful is a complete urinary tract ultrasound in orchiepididymitis?

<p>Assessing the Utility of Ultrasound and Urinalysis for Patients with Possible Epididymo-Orchitis – A Retrospective Study</p>

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