Journal of pediatric urology · 2026
Empirical antibiotic prophylaxis versus culture-directed enhanced prophylaxis for prevention of urinary tract infection after flexible ureteroscopy in children: A randomized controlled trial.
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Arafa Hisham, Mostafa Diaaeldin, Salim Mohamed S, Amin Ashraf, Farouk Ahmed
Аннотация
OBJECTIVE: This study aims to compare the effects of empirical antibiotic prophylaxis versus culture-directed enhanced prophylactic measures on the rate of urinary tract infection (UTI) after flexible ureteroscopy (FURS) in children.
METHODS: A randomized controlled study was conducted at our tertiary center between July 1, 2024, and December 1, 2024, involving 140 patients with renal or ureteric stones. Patients were randomly allocated to receive either empirical antibiotic or culture-directed enhanced prophylaxis (preoperative urine culture followed by culture-directed antibiotic therapy when indicated). Stone burden was determined using non-contrast computed tomography of the urinary tract (NCCT). The primary outcome was the incidence of postoperative symptomatic UTI within 30 days, defined as the presence of fever (<38 °C), poor appetite, lethargy, or vomiting, accompanied by elevated inflammatory markers (TLC, CRP, ESR), pyuria on urinalysis, and a positive urine culture. Secondary outcomes included overall postoperative complication rate (Clavien-Dindo), hospitalization time, readmission rate, operative time, and specific complications (fever, hematuria, narcotic use and febrile UTI which was defined as documented UTI associated with elevated temperature (>38 °C) and suspected sepsis without organ failure requiring supportive therapy and enhanced monitoring in addition to the antibiotic therapy.
INCLUSION CRITERIA: age 4-16 years, renal/ureteric stones 1-1.5 cm.
EXCLUSION CRITERIA: congenital renal anomalies, single functioning kidney, active symptomatic UTI at time of randomization, neuropathic bladder, diabetes, coagulopathy, elevated creatinine, or cardiorespiratory comorbidity.
RESULTS: Patient and stone characteristics were similar in both groups. There was no statistically significant difference between groups according to hospitalization time, readmission rates, or intraoperative complications. The overall post-operative complication rate and symptomatic UTI was 57.2% and 18.6% for empirical prophylaxis compared to 29.9% and 7.1% for culture-directed enhanced prophylaxis; this difference was statistically significant (p-value = 0.001 and 0.043, respectively). While postoperative fever <38 °C was managed conservatively, postoperative narcotic use for pain control, hematuria, and febrile UTI showed no statistically significant differences between the two groups (p = 0.091, 0.346, 0.698, and 0.346, respectively).
CONCLUSION: Although empirical antibiotic prophylaxis offers a basic level of prevention of UTI post FURS, enhanced prophylactic measures with targeted antibiotic therapy and optimal dosing, show a more substantial reduction in UTI and complication rates.
METHODS: A randomized controlled study was conducted at our tertiary center between July 1, 2024, and December 1, 2024, involving 140 patients with renal or ureteric stones. Patients were randomly allocated to receive either empirical antibiotic or culture-directed enhanced prophylaxis (preoperative urine culture followed by culture-directed antibiotic therapy when indicated). Stone burden was determined using non-contrast computed tomography of the urinary tract (NCCT). The primary outcome was the incidence of postoperative symptomatic UTI within 30 days, defined as the presence of fever (<38 °C), poor appetite, lethargy, or vomiting, accompanied by elevated inflammatory markers (TLC, CRP, ESR), pyuria on urinalysis, and a positive urine culture. Secondary outcomes included overall postoperative complication rate (Clavien-Dindo), hospitalization time, readmission rate, operative time, and specific complications (fever, hematuria, narcotic use and febrile UTI which was defined as documented UTI associated with elevated temperature (>38 °C) and suspected sepsis without organ failure requiring supportive therapy and enhanced monitoring in addition to the antibiotic therapy.
INCLUSION CRITERIA: age 4-16 years, renal/ureteric stones 1-1.5 cm.
EXCLUSION CRITERIA: congenital renal anomalies, single functioning kidney, active symptomatic UTI at time of randomization, neuropathic bladder, diabetes, coagulopathy, elevated creatinine, or cardiorespiratory comorbidity.
RESULTS: Patient and stone characteristics were similar in both groups. There was no statistically significant difference between groups according to hospitalization time, readmission rates, or intraoperative complications. The overall post-operative complication rate and symptomatic UTI was 57.2% and 18.6% for empirical prophylaxis compared to 29.9% and 7.1% for culture-directed enhanced prophylaxis; this difference was statistically significant (p-value = 0.001 and 0.043, respectively). While postoperative fever <38 °C was managed conservatively, postoperative narcotic use for pain control, hematuria, and febrile UTI showed no statistically significant differences between the two groups (p = 0.091, 0.346, 0.698, and 0.346, respectively).
CONCLUSION: Although empirical antibiotic prophylaxis offers a basic level of prevention of UTI post FURS, enhanced prophylactic measures with targeted antibiotic therapy and optimal dosing, show a more substantial reduction in UTI and complication rates.