Incidence of febrile post-procedural urinary tract infection following voiding cystourethrography in children without prior urine culture.
Child
Pediatrics
Safety
Urinary tract infection
Urine sterility
Voiding cystourethrography
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
31 Aug 2024
31 Aug 2024
Historique:
received:
25
06
2024
accepted:
12
08
2024
medline:
1
9
2024
pubmed:
1
9
2024
entrez:
31
8
2024
Statut:
epublish
Résumé
Post-procedural urinary tract infections (ppUTIs) following voiding cystourethrography (VCUG) vary widely, with rates from 0 to 42%, though recent studies suggest rates typically below 5%. Verifying urine sterility before VCUG is traditionally done but questioned. This study assessed the 7-day ppUTI rate post-VCUG without prior urine sterility confirmation and identified associated risk factors. A retrospective review of VCUG cases in children under three years at a pediatric hospital over two years was conducted. Exclusions included neuropathic bladder, bladder exstrophy, pre-VCUG urine cultures, and lost-to-follow-up cases. Achieving a ppUTI rate below 5% would support safe VCUG practice without pre-urine culture. Of 318 VCUGs performed on 300 children, 248 (78%) were males (8% circumcised) with a median age of 5 months. Retrograde VCUG was more common than suprapubic cystography (63% vs. 37%). Before the test, 33.6% received antibiotics, mostly prophylactically. Hydronephrosis was present in 66.4%, and 69% had a history of UTI. VCUG results were abnormal in 43% of cases: 85% had vesicoureteral reflux (VUR), 10% had posterior urethral valves (PUV), and 28% had other abnormalities. The 7-day ppUTI rate was 3.8%, with 67% of ppUTI cases having abnormal VCUG results versus 41% without ppUTI (p = 0.06). No significant risk factors for ppUTI were identified. Omitting systematic urine culture before VCUG was not associated with a high ppUTI rate, even in children with pre-existing urologic conditions or a history of UTI, indicating that VCUG can be safely performed without prior urine sterility confirmation. No risk factors for ppUTI were identified.
Identifiants
pubmed: 39215768
doi: 10.1007/s00345-024-05217-5
pii: 10.1007/s00345-024-05217-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
499Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Pattaragarn A, Alon US (2002) Urinary tract infection in childhood. Review of guidelines and recommendations. Minerva Pediatr 54(5):401–413
pubmed: 12244278
Committee on Quality Improvement, Subcommittee on Urinary Tract Infection (1999) Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 103(41):843–852
doi: 10.1542/peds.103.4.843
Riccabona M (2002) Cystography in infants and children: a critical appraisal of the many forms with special regard to voiding cystourethrography. Eur Radiol 12(12):2910–2918
doi: 10.1007/s00330-002-1430-2
pubmed: 12439570
Frimberger D, Bauer SB, Cain MP, Greenfield SP, Kirsch AJ, Ramji F et al (2016) Establishing a standard protocol for the voiding cystourethrography. J Pediatr Urol 12(6):362–366
doi: 10.1016/j.jpurol.2016.11.001
pubmed: 27939178
Zerin JM, Shulkin BL (1992) Postprocedural symptoms in children who undergo imaging studies of the urinary tract: is it the contrast material or the catheter? Radiology 182(3):727–730
doi: 10.1148/radiology.182.3.1311117
pubmed: 1311117
Guignard JP (1979) Urinary infection after micturating cystography. Lancet 1(8107):103
doi: 10.1016/S0140-6736(79)90091-6
pubmed: 84106
Maskell R, Pead L, Vinnicombe J (1978) Urinary infection after micturating cystography. Lancet 2(8101):1191–1192
doi: 10.1016/S0140-6736(78)92169-4
pubmed: 82153
Rachmiel M, Aladjem M, Starinsky R, Strauss S, Villa Y, Goldman M (2005) Symptomatic urinary tract infections following voiding cystourethrography. Pediatr Nephrol 20(10):1449–1452
doi: 10.1007/s00467-005-1942-5
pubmed: 16047224
Hallett RJ, Pead L, Maskell R (1976) Urinary infection in boys. A three-year prospective study. Lancet 2(7995):1107–1110
doi: 10.1016/S0140-6736(76)91087-4
pubmed: 62948
Johnson EK, Malhotra NR, Shannon R, Jacobson DL, Green J, Rigsby CK et al (2017) Urinary tract infection after voiding cystourethrogram. J Pediatr Urol 13(4):384.e1-384.e7
doi: 10.1016/j.jpurol.2017.04.018
pubmed: 28579135
Martins JS, Pinto M, Braga M, Calhau P (2020) Incidence of urinary tract infection after cystrography. Rev Paul Pediatr 39:e2019386
doi: 10.1590/1984-0462/2021/39/2019386
pubmed: 33237135
pmcid: 7681943
Malhotra NR, Green JR, Rigsby CK, Holl JL, Cheng EY, Johnson EK (2017) Urinary tract infection after retrograde urethrogram in children: a multicenter study. J Pediatr Urol 13(6):623.e1-623.e5
doi: 10.1016/j.jpurol.2017.04.026
pubmed: 28666918
Moorani KN, Parkash J, Lohano MK (2010) Urinary tract infection in children undergoing diagnostic voiding cystourethrography. J Surg Pak 15:68–72
Vates TS, Shull MJ, Underberg-Davis SJ, Fleisher MH (1999) Complications of voiding cystourethrography in the evaluation of infants with prenatally detected hydronephrosis. J Urol 162(3 Pt 2):1221–1223
doi: 10.1016/S0022-5347(01)68140-0
pubmed: 10458471
Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE (1985) International system of radiographic grading of vesicoureteric reflux. Pediatr Radiol 15(2):105–109
doi: 10.1007/BF02388714
pubmed: 3975102
Okarska-Napierała M, Wasilewska A, Kuchar E (2017) Urinary tract infection in children: diagnosis, treatment, imaging - comparison of current guidelines. J Pediatr Urol 13(6):567–573
doi: 10.1016/j.jpurol.2017.07.018
pubmed: 28986090
Soylu A, Kasap B, Demir K, Türkmen M, Kavukçu S (2007) Predictive value of clinical and laboratory variables for vesicoureteral reflux in children. Pediatr Nephrol 22(6):844–848
doi: 10.1007/s00467-006-0418-6
pubmed: 17273861
Zhang H, Yang J, Lin L, Huo B, Dai H, He Y (2016) Diagnostic value of serum procalcitonin for acute pyelonephritis in infants and children with urinary tract infections: an updated meta-analysis. World J Urol 34(3):431–441
doi: 10.1007/s00345-015-1630-4
pubmed: 26142087
Schlager TA, Hendley JO, Dudley SM, Hayden GF, Lohr JA (1995) Explanation for false-positive urine cultures obtained by bag technique. Arch Pediatr Adolesc Med 149(2):170–173
doi: 10.1001/archpedi.1995.02170140052007
pubmed: 7849878
Schmidt B, Copp HL (2015) Work-up of pediatric urinary tract infection. Urol Clin North Am 42(4):519–526
doi: 10.1016/j.ucl.2015.05.011
pubmed: 26475948
pmcid: 4914380
Doern CD, Richardson SE (2016) Diagnosis of urinary tract infections in children. J Clin Microbiol 54(9):2233–2242
doi: 10.1128/JCM.00189-16
pubmed: 27053673
pmcid: 5005475
Verliat-Guinaud J, Blanc P, Garnier F, Gajdos V, Guigonis V (2015) A midstream urine collector is not a good alternative to a sterile collection method during the diagnosis of urinary tract infection. Acta Paediatr sept 104(9):e395-400
doi: 10.1111/apa.13019
Robinson JL, Finlay JC, Lang ME, Bortolussi R (2014) Urinary tract infections in infants and children: diagnosis and management. Paediatr Child Health 19(6):315–325
doi: 10.1093/pch/19.6.315
pubmed: 25332662
pmcid: 4173959
Pescheloche P, Gallon J, Parier B, Ze Ondo C, Bessede T, Irani J (2019) Is it necessary to test the sterility of urine prior to outpatient cystoscopy? J Hosp Infect 101(4):483–485
doi: 10.1016/j.jhin.2019.01.016
pubmed: 30664914
Fineberg HV, Hiatt HH (1979) Evaluation of medical practices. The case for technology assessment. N Engl J Med 301(20):1086–1091
doi: 10.1056/NEJM197911153012004
pubmed: 114833
Baltimore RS (2004) Burkholderia, and Stenotrophomonas. Pseudomonas. In: Behrman RE, Kliegman RM, Jenson HB (eds) Nelson textbook of pediatrics, 17th edn. Saunders, Philadelphia, pp 934–936
Ismaili K, Avni FE, Hall M (2002) Results of systematic voiding cystourethrography in infants with antenatally diagnosed renal pelvis dilation. J Pediatr 141(1):21–24
doi: 10.1067/mpd.2002.125493
pubmed: 12091846
Lee LC, Lorenzo AJ, Koyle MA (2016) The role of voiding cystourethrography in the investigation of children with urinary tract infections. Can Urol Assoc J 10(5–6):210–214
doi: 10.5489/cuaj.3610
pubmed: 27713802
pmcid: 5045350
Omogbehin B, Willich E (1975) Suprapubic micturition cystourethrography in infancy and childhood. Pediatr Radiol 3(1):20–23
doi: 10.1007/BF00973361
pubmed: 1241917
Sinha R, Saha S, Maji B, Tse Y (2017) Antibiotics for performing voiding cystourethrogram: a randomised control trial. Arch Dis Child 103(3):230–234
doi: 10.1136/archdischild-2017-313266
pubmed: 28855226