Urology · 2025
Contemporary Analysis of 30-Day UTI Rates Post-ureteral Reimplantation in VUR Patients: Evaluating the Role of Discharge Antibiotics.
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Pfail John, Passarelli Rachel, Concodora Charles, Ahmed Haris, Barone Joseph G, Wu Wayland J
Аннотация
OBJECTIVE: To evaluate 30-day postoperative urinary tract infection (UTI) rates in children with vesicoureteral reflux (VUR) undergoing ureteral reimplantation, assessing the impact of discharge antibiotics.
METHODS: This retrospective cohort study utilized the pediatric National Surgical Quality Improvement Program VUR-specific dataset to analyze patients who underwent ureteral reimplantation for VUR. We compared 30-day UTI rates, readmissions, and ER visits between those discharged with and without antibiotics. Multivariable logistic regression identified independent predictors of UTIs.
RESULTS: Of the 3004 patients included who underwent ureteral reimplant, 2509 (84%) and 495 (16%) were discharged with or without antibiotics, respectively. On univariable analysis, the proportion of patients who experienced 30-day readmission (3.9% vs 5.3%), emergency room visits (10.5% vs 10.5%), and UTI (2.4% vs 3.2%) did not differ according to discharge antibiotic use (antibiotics vs no antibiotics, respectively, all P>.05). On MVA, age (Odds Ratio [OR]: 0.986, 95% CI: 0.978-0.994) and female sex (OR: 1.782, 95% CI: 1.005-3.162) were found to be significant predictors of UTI occurrence. Conversely, the prescription of antibiotics at discharge (OR: 1.564, 95% CI: 0.886-2.763) did not show a significant impact on UTI rates.
CONCLUSION: Age and sex are predictive of UTI risk within 30 days following ureteral reimplantation for VUR. The absence of significant associations for reflux grade, perioperative stent use, or prophylactic antibiotic administration at discharge suggests that routine prescription of antibiotics post-discharge may not reduce early UTI risk. These findings can guide postoperative care and help tailor antibiotic stewardship efforts in pediatric urology.
METHODS: This retrospective cohort study utilized the pediatric National Surgical Quality Improvement Program VUR-specific dataset to analyze patients who underwent ureteral reimplantation for VUR. We compared 30-day UTI rates, readmissions, and ER visits between those discharged with and without antibiotics. Multivariable logistic regression identified independent predictors of UTIs.
RESULTS: Of the 3004 patients included who underwent ureteral reimplant, 2509 (84%) and 495 (16%) were discharged with or without antibiotics, respectively. On univariable analysis, the proportion of patients who experienced 30-day readmission (3.9% vs 5.3%), emergency room visits (10.5% vs 10.5%), and UTI (2.4% vs 3.2%) did not differ according to discharge antibiotic use (antibiotics vs no antibiotics, respectively, all P>.05). On MVA, age (Odds Ratio [OR]: 0.986, 95% CI: 0.978-0.994) and female sex (OR: 1.782, 95% CI: 1.005-3.162) were found to be significant predictors of UTI occurrence. Conversely, the prescription of antibiotics at discharge (OR: 1.564, 95% CI: 0.886-2.763) did not show a significant impact on UTI rates.
CONCLUSION: Age and sex are predictive of UTI risk within 30 days following ureteral reimplantation for VUR. The absence of significant associations for reflux grade, perioperative stent use, or prophylactic antibiotic administration at discharge suggests that routine prescription of antibiotics post-discharge may not reduce early UTI risk. These findings can guide postoperative care and help tailor antibiotic stewardship efforts in pediatric urology.