The following is the summary of “Pyeloplasty with ureteral stent placement in children: Do prophylactic antibiotics serve a purpose?” published in the December 2022 issue of Pediatric urology by Vidovic, et al.
Ureteral stents are routinely implanted during pyeloplasty to promote proper drainage and anastomosis healing. Because of the prevalence of urinary tract infections (UTI), antibiotic prophylaxis is commonly employed. There is a lack of consensus on the use of prophylactic antibiotics after pyeloplasty, therefore, the practice varies greatly among surgeons. Researchers hypothesize that there is no major difference in the stent UTI rate between children who are given antibiotics and those who are not. In this study, investigators analyzed data from 741 patients treated with pyeloplasty at seven different hospitals between January 2010 and July 2018. Age over 22, failure to insert a stent, using externally placed stents, and missing or inadequate data were all disqualifying factors.
The procedure used in surgery, patient age, antibiotics, stent and Foley tube lengths, and urine culture findings were all noted. Patients were divided into two groups based on their age: those younger than four years old and those aged four years and up, to account for the likelihood that they would require diapers. To determine risk factors for UTI, a univariate logistic regression analysis was carried out. A univariate logistic regression analysis was carried out to determine risk factors for UTIe Akaike information criterion for making model choices. After accounting for confounding factors such as patient age, gender, and intraoperative urine culture results, the selected model was used to determine odds ratios and 95% CI for the connection between prophylactic antibiotics and stent UTI. A total of 672 people participated; 338 of them got antibiotic prophylaxis. The average ages of the 2 groups were significantly different (3.91 and 6.91 years, respectively, P< .001), as were the median stent durations (38.5 and 35.32 days, respectively, P<.001) and the surgical approaches (53.25% open vs. 32.04% laparoscopic, P<.001). Overall, the rate of stent-related UTIs was low (7.59%), and it was similar in the two groups: 31/338 (9.17%) in the prophylaxis group and 20/334 (5.79%) in the non-prophylaxis group (P=.119).
Despite the fact that prophylactic antibiotic use was not associated with a significantly lower risk of stent UTI in any of the groups studied (female gender, likely diaper use, and positive intra-operative urine culture), these risk factors were independently associated with a significantly higher risk of stent UTI. There was no correlation between stent UTI and surgical method, stent duration, or Foley duration. Stent-related urinary tract infections (UTIs) are uncommon after pyeloplasty. Risk factors such as female gender, likely diaper use, and a positive intra-operative urine culture have no effect on the association between prophylactic antibiotics and decreased rates of stent UTI after pyeloplasty. Therefore, antibiotic prophylaxis following pyeloplasty does not appear to be helpful in general, and may be saved for patients with numerous risk factors for UTI.