M Chad Wallis1, Pangaja Paramsothy2, Kimberly Newsome2, Tonya Williams2, Jonathan C Routh3, David B Joseph4, Earl Cheng5, Duong Tu6, J Chris Austin7, Stacy T Tanaka8, William O Walker9, Kathryn A Smith10, Michelle A Baum11, John S Wiener3. 1. Division of Urology, Primary Children's Hospital, Salt Lake City, Utah. 2. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia. 3. Division of Urology, Duke University Medical Center, Durham, North Carolina. 4. Department of Urology, University of Alabama-Birmingham, Birmingham, Alabama. 5. Division of Urology, Lurie Children's Hospital of Chicago, Chicago, Illinois. 6. Division of Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas. 7. Department of Urology, Oregon Health Sciences University, Portland, Oregon. 8. Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. 9. Division of Developmental Medicine, Seattle Children's Hospital, Seattle, Washington. 10. Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California. 11. Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts.
Abstract
PURPOSE: Urinary tract infections commonly occur in patients with spina bifida and pose a risk of renal scarring. Routine antibiotic prophylaxis has been utilized in newborns with spina bifida to prevent urinary tract infections. We hypothesized that prophylaxis can safely be withheld in newborns with spina bifida until clinical assessment allows for risk stratification. MATERIALS AND METHODS: Newborns with myelomeningocele at 9 institutions were prospectively enrolled in the UMPIRE study and managed by a standardized protocol with a strict definition of urinary tract infection. Patient data were collected regarding details of reported urinary tract infection, baseline renal ultrasound findings, vesicoureteral reflux, use of clean intermittent catheterization and circumcision status in boys. Risk ratios and corresponding 95% confidence intervals were calculated using log-binomial models. RESULTS: From February 2015 through August 2019 data were available on 299 newborns (50.5% male). During the first 4 months of life, 48 newborns (16.1%) were treated for urinary tract infection with 23 (7.7%) having positive cultures; however, only 12 (4.0%) met the strict definition of urinary tract infection. Infants with grade 3-4 hydronephrosis had an increased risk of urinary tract infection compared to infants with no hydronephrosis (RR=10.1; 95% CI=2.8, 36.3). Infants on clean intermittent catheterization also had an increased risk of urinary tract infection (RR=3.3; 95% CI=1.0, 10.5). CONCLUSIONS: The incidence of a culture positive, symptomatic urinary tract infection among newborns with spina bifida in the first 4 months of life was low. Patients with high grades of hydronephrosis or those on clean intermittent catheterization had a significantly greater incidence of urinary tract infection. Our findings suggest that routine antibiotic prophylaxis may not be necessary for most newborns with spina bifida.
PURPOSE: Urinary tract infections commonly occur in patients with spina bifida and pose a risk of renal scarring. Routine antibiotic prophylaxis has been utilized in newborns with spina bifida to prevent urinary tract infections. We hypothesized that prophylaxis can safely be withheld in newborns with spina bifida until clinical assessment allows for risk stratification. MATERIALS AND METHODS: Newborns with myelomeningocele at 9 institutions were prospectively enrolled in the UMPIRE study and managed by a standardized protocol with a strict definition of urinary tract infection. Patient data were collected regarding details of reported urinary tract infection, baseline renal ultrasound findings, vesicoureteral reflux, use of clean intermittent catheterization and circumcision status in boys. Risk ratios and corresponding 95% confidence intervals were calculated using log-binomial models. RESULTS: From February 2015 through August 2019 data were available on 299 newborns (50.5% male). During the first 4 months of life, 48 newborns (16.1%) were treated for urinary tract infection with 23 (7.7%) having positive cultures; however, only 12 (4.0%) met the strict definition of urinary tract infection. Infants with grade 3-4 hydronephrosis had an increased risk of urinary tract infection compared to infants with no hydronephrosis (RR=10.1; 95% CI=2.8, 36.3). Infants on clean intermittent catheterization also had an increased risk of urinary tract infection (RR=3.3; 95% CI=1.0, 10.5). CONCLUSIONS: The incidence of a culture positive, symptomatic urinary tract infection among newborns with spina bifida in the first 4 months of life was low. Patients with high grades of hydronephrosis or those on clean intermittent catheterization had a significantly greater incidence of urinary tract infection. Our findings suggest that routine antibiotic prophylaxis may not be necessary for most newborns with spina bifida.
Authors: Stacy T Tanaka; Pangaja Paramsothy; Judy Thibadeau; John S Wiener; David B Joseph; Earl Y Cheng; Duong Tu; Christopher Austin; Chester J Koh; M Chad Wallis; William O Walker; Kathryn A Smith; Jonathan C Routh; Michelle A Baum Journal: J Urol Date: 2019-06 Impact factor: 7.450
Authors: Guido Filler; Mireille Gharib; Shelley Casier; Petra Lödige; Jochen H H Ehrich; Sumit Dave Journal: Int Urol Nephrol Date: 2011-01-13 Impact factor: 2.370
Authors: Raimund Stein; Guy Bogaert; Hasan S Dogan; Lisette Hoen; Radim Kocvara; Rien J M Nijman; Josine S L T Quadackers; Yazan F Rawashdeh; Mesrur S Silay; Serdar Tekgul; Christian Radmayr Journal: Neurourol Urodyn Date: 2019-11-13 Impact factor: 2.696
Authors: Jonathan C Routh; Earl Y Cheng; J Christopher Austin; Michelle A Baum; Patricio C Gargollo; Richard W Grady; Adrienne R Herron; Steven S Kim; Shelly J King; Chester J Koh; Pangaja Paramsothy; Lisa Raman; Michael S Schechter; Kathryn A Smith; Stacy T Tanaka; Judy K Thibadeau; William O Walker; M Chad Wallis; John S Wiener; David B Joseph Journal: J Urol Date: 2016-07-27 Impact factor: 7.450