Investig Clin Urol.  2020 Mar;61(2):200-206. 10.4111/icu.2020.61.2.200.

The role of antibiotic prophylaxis in mild to moderate isolated hydronephrosis detected in antenatal screening

Affiliations
  • 1Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. pornpimol.r@chula.ac.th

Abstract

PURPOSE
To determine whether continuous antibiotic prophylaxis (CAP) could prevent urinary tract infection (UTI) in mild to moderate antenatal isolated hydronephrosis (IH), characterized by hydronephrosis without ureter and bladder abnormalities, and anteroposterior renal pelvis diameter <16 mm and the Society for Fetal Urology grade <4, in neonatal renal ultrasound.
MATERIALS AND METHODS
Eighty neonates aged 7 to 30 days, with antenatal hydronephrosis and mild to moderate IH on neonatal renal ultrasound, were recruited from August 2015 to December 2016. Neonates were randomly assigned to CAP until hydronephrosis resolution or aged 12 months (CAP group, n=40) or to watchful observation (control group, n=40). The primary outcome was UTI. The probability of UTI was compared between the randomized groups using the Kaplan-Meier method and the log-rank test.
RESULTS
Nonadherence occurred in 6/40 parents in the CAP arm (15.0%). Thus, only 34 patients received CAP. UTI occurred in 5/34 patients in the CAP group (14.7%) and in 4/40 controls (10.0%). The probability of UTI was increased in the CAP group (hazard ratio, 1.38; 95% confidence interval, 0.37-5.16; p=0.63). UTI caused by cotrimoxazole resistant bacteria was four times higher in the CAP group than in controls (relative risk, 4.0; 95% confidence interval, 1.2-13.5; p=0.02). The trial was prematurely terminated due to the negative impact of CAP on bacterial sensitivity.
CONCLUSIONS
The benefits of CAP in infants with mild to moderate IH were inconclusive. CAP conferred a high risk of resistant bacterial organisms when UTI occurs.

Keyword

Anti-bacterial agents; Child; Clinical trial; Hydronephrosis; Urinary tract infections

MeSH Terms

Anti-Bacterial Agents
Antibiotic Prophylaxis*
Arm
Bacteria
Child
Humans
Hydronephrosis*
Infant
Infant, Newborn
Kidney Pelvis
Methods
Parents
Prenatal Diagnosis*
Trimethoprim, Sulfamethoxazole Drug Combination
Ultrasonography
Ureter
Urinary Bladder
Urinary Tract Infections
Urology
Anti-Bacterial Agents
Trimethoprim, Sulfamethoxazole Drug Combination
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