Is it appropriate to administer antibiotic prophylaxis to infants with severe hydronephrosis before pyeloplasty?


Authors: Oldřich Šmakal 1;  Jan Šarapatka 1;  Hana Flögelová 2;  Lenka Bakaj-Zbrožková 3
Authors‘ workplace: Urologická klinika LF UP a FN, Olomouc 1;  Dětská klinika LF UP a FN, Olomouc 2;  Radiologická klinika LF UP a FN, Olomouc 3
Published in: Ces Urol 2013; 17(3): 193-198
Category: Original article

Overview

Aim:
The aim of this study was to assess the development of acute pyelonephritis (APN) in infants with hydronephrosis, detected using ultrasonography (USG), and severe ureteropelvic junction obstruction requiring pyeloplasty. Based on the results, we evaluated the necessity for antibiotic prophylaxis until the time of surgery.

Methods:
A prospective study was performed to assess the presence of APN prior to pyeloplasty in infants with severe dilatation of the renal pelvicalyceal system (PCS). The infants underwent standard USG and MAG3 scintigraphy examinations. In those with APN, a voiding cystourethrogram was performed. During follow-up, none of the infants received primary antibiotic prophylaxis; none of the male infants were circumcised. The analysis included USG and radionuclide parameters, age and gender.

Results:
A total of 97 infants underwent surgery. APN was found in 5 boys (5.2%) with a mean age of 1.4 months. Infants with a history of urinary tract infection had a renal pelvic diameter of 11–22 mm, parenchymal thickness of 2–7 mm and relative kidney function of 40–54%. There was no statistically significant association between APN and age, gender and USG or radio-nuclide parameters. Substantive significance of APN was found in boys less than 3 months of age compared with girls of the same age and infants older than 3 months.

Conclusion:
The results suggest that routine administration of antibiotic prophylaxis is not necessary in infants during follow-up for severe dilatation of the PCS. Prophylaxis should be individually considered in boys less than 3 months of age who most frequently developed APN.

Key words:
acute pyelonephritis, antibiotic prophylaxis, hydronephrosis, pyeloplasty.


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Labels
Paediatric urologist Nephrology Urology
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