Antenatal urinary tract dilation: does continuous antibiotic prophylaxis prevent UTI in newborns?

  • Varda BK & al.
  • J Pediatr Urol
  • 29 May 2018

  • curated by Craig Hicks
  • Clinical Essentials
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Takeaway

  • Administering continuous antibiotic prophylaxis (CAP) before postnatal imaging to newborns with antenatal urinary tract dilation (AUTD) may benefit most patients.

Why this matters

  • "[C]ontemporary practice patterns surrounding the use of CAP in AUTD patients vary greatly,” say researchers. "Close to 50% of providers do not use CAP at all, even in patients with a history of Grade 3 or 4 AUTD."

Study design

  • Researchers studied newborns with a history of AUTD (n=494), comparing incidence of early UTI among infants who did or did not receive postnatal antibiotic prophylaxis.
  • Primary outcome: incidence of UTI between birth and the first postnatal renal ultrasound evaluation (RUS).
  • Funding: Harvard University; NIH; Agency for Healthcare Research & Quality; Thrasher Research Foundation.

Key results

  • 32% of patients (157) received CAP.
  • 1.4% (7) developed UTI before imaging: 6 without CAP vs 1 with CAP (P=.44).
  • Propensity score-adjusted odds of developing UTI with CAP (vs without) were 0.93 (P=.95).

Limitations

  • The study was retrospective and single-center.
  • Low UTI incidence may mean the study was underpowered to detect risk reduction associated with CAP.

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