Prophylactic Antibiotics and Pyeloplasty With Ureteral Stent – New Study Explores Efficacy/Ongoing Use

A multicenter team, including UPMC Children’s Hospital of Pittsburgh Division of Pediatric Urology, conducted a study to determine if prophylactic antibiotics improve outcomes in children undergoing pyeloplasty with ureteral stent placement.

The study was published in the Journal of Pediatric Urology in December 2022. Division chief Glenn M. Cannon, MD, was a contributing author from UPMC Children’s, along with former division fellow, Marc A. Colaco, MD, MBA.

“Ureteral stents are commonly used in pyeloplasty procedures, as is the case with prophylactic antibiotics as a safeguard against urinary tract infection," says Dr. Cannon. "However, there isn't consensus in the field on how or when it is best to use antimicrobial therapy, or even if their use demonstrably improves outcomes related to UTI. This study was designed to help answer some of these questions."

Study Overview and Key Findings

The investigation pooled data from seven medical centers, which produced a cohort of 672 cases of pyeloplasty with the placement of a ureteral stent (US) between January 2010 and July 2018 (that met all study inclusion/exclusion criteria). The study team further divided the patient cohort by age into two groups: greater than and less than four years. This segmentation was done to account for the likely use of diapers in the younger cohort.

Of the examined cases, 338 were administered prophylactic antibiotics, while 334 were not.

Across both groups, the overall rate of urinary tract infection (UTI) was found to be low, at 7.57%, and also similar between the two groups with the nonantibiotic cohort experiencing a rate of 5.99% while the prophylactic antibiotic group UTI rate was 9.17%.

Across virtually all measures and accounting for variances in surgical approach, duration of stent placement, and duration of foley catheter use, there was no statistically significant benefit to receiving prophylactic antibiotics for preventing UTI.

However, the study uncovered that female gender, the use of diapers, and a positive intraoperative urine culture were associated with “significantly” higher rates of UTI.

“This study provides robust data for curtailing the use of prophylactic antibiotics for these patients, but also for more thoughtfully targeting them at patients with multiple risk factors such as those we identified," says Dr. Cannon. "Anytime we can avoid the unnecessary use of antibiotics in any patient that will see no benefit, and in particular children, is a good thing given the potential side effects of their use, the global spread of multidrug-resistant pathogens due to multiple factors, and our dearth of newer agents that can deal with these superbugs when they emerge."

Read more about the study using the reference link below.

Reference

Vidovic S, Hayes T, Fowke J, Cline JK, Cannon GM, Colaco MA, Swords KA, Cornwell LB, Villanueva C, Corbett ST, Maciolek K, Lambert SM, Beltran G, Vemulakona VM, Giel DW. Pyeloplasty With Ureteral Stent Placement in Children: Do Prophylactic Antibiotics Serve a Purpose? J Pediatr Urol. 2022 Dec; 18(6): 804-811.