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DOI: 10.1055/a-1303-4695
Febrile Urinary Tract Infections in Children with Primary Non-Refluxing Megaureter: A Systematic Review and Meta-Analysis
Fieberhafte Harnwegsinfektionen bei Kindern mit primärem nicht-refluxivem Megaureter: Eine systematische Übersichtsarbeit und Metaanalyse Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.![](https://www.thieme-connect.de/media/klinpaed/202201/lookinside/thumbnails/2020-08-1312_10-1055-a-1303-4695-1.jpg)
Abstract
Background Knowledge of the baseline risk of febrile urinary tract infections in patients with primary non-refluxing megaureter can help clinicians to make informed decisions for offering continuous antibiotic prophylaxis.
Objective The primary objective of this systematic review was to determine the pooled prevalence of febrile urinary tract infections in patients with primary non-refluxing megaureter selected for primary non-surgical management independent of associated attributed risk factors at initial presentation in order to assess the value of continuous antibiotic prophylaxis.
Methods MEDLINE, EMBASE, and Cochrane Controlled Trials Register electronic databases were searched for eligible studies without language and time restriction. The systematic review was carried out following the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. (PROSPERO registration number CRD42018104752).
Results Of 25 871 records, 16 studies (n=749 patients) were eligible for inclusion. The overall pooled prevalence of febrile urinary tract infections in patients with primary non-refluxing megaureter was 14.35% (95% confidence interval: 8.8–22.6). The calculated number needed to treat for patients on continuous antibiotic prophylaxis to prevent one single febrile urinary tract infection over the course of 1–2 years would be 4.3.
Conclusion Based on the current available evidence the use of continuous antibiotic prophylaxis for children with PM selected for primary non-surgical treatment should be taken into consideration, at least in patients with urinary outflow impairment, higher grade of ureteral dilatation, and for children in the first months of life.
Zusammenfassung
Hintergrund Die Kenntnis der Prävalenz fieberhafter Harnwegsinfektionen bei Kindern mit nicht-refluxivem primärem Megaureter, die zunächst für eine nicht-chirurgische Behandlung ausgewählt wurden, kann zu einer informierten Entscheidungsfindung über den Nutzen einer antibiotischen Dauerprophylaxe beitragen. Primäres Ziel der systematischen Übersichtsarbeit und Meta-Analyse war die Ermittlung des Risikos von fieberhaften Harnwegsinfektionen unabhängig von assoziierten Risikofaktoren mit anschließender Subgruppenanalyse.
Studiendesign Die elektronischen Datenbanken MEDLINE, EMBASE und Cochrane Controlled Trials Register wurden ohne Sprach- und Zeitbeschränkung nach relevanten Studien durchsucht. Die systematische Übersichtsarbeit wurde entsprechend den Empfehlungen der Cochrane Collaboration und den „Preferred Reporting Items for Systematic Reviews and Meta-Analyses“ durchgeführt (PROSPERO-Registriernummer CRD42018104752).
Ergebnisse 16 Studien (n=749 Patienten) erfüllten die Einschlusskriterien. Die gepoolte Gesamtprävalenz fieberhafter Harnwegsinfektionen bei Patienten mit nicht-refluxivem primärem Megaureter war 14,35% (95% Konfidenzintervall: 8,8–22,6). Aus diesen Daten kann vermutet werden, dass eine antibiotische Dauerprophylaxe über einen Zeitraum von 1–2 Jahren 4,3 Kindern gegeben werden muss um 1 fieberhafte Harnwegsinfektion vermeiden zu können.
Schlussfolgerung Anhand der derzeit verfügbaren Daten sollte eine antibiotische Prophylaxe bei Kinder mit nicht-refluxivem primärem Megaureter in Erwägung gezogen werden, insbesondere bei höhergradiger Harnabflussstörung und/oder Ureterdilatation sowie in den ersten Lebensmonaten.
Keywords
antibiotic prophylaxis - obstruction - primary non-refluxing megaureter - ureteral dilatation - urinary tract infectionSchlüsselwörter
antibiotische Prophylaxe - Obstruktion - Primärer nicht refluxiver Megaureter - Ureterdilatation - HarnwegsinfektionPublication History
Article published online:
17 December 2020
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References
- 1 Amato D, Garduno-Espinosa J. Circumcision in the newborn child and risk of urinary tract infection during the first year of life. A meta-analysis. Bol Med Hosp Infant Mex 1992; 49: 652-658
- 2 Austin PC, Laupacis A. A tutorial on methods to estimating clinically and policy-meaningful measures of treatment effects in prospective observational studies: a review. Int J Biostat 2011; 7: 6
- 3 Baskin LS, Zderic SA, Snyder HM. et al. Primary dilated megaureter: long-term followup. Journal of Urology 1994; 152: 618-621
- 4 Beetz R, Fisch M, Hohenfellner U. Primäre und sekundäre Megaureteren. Beetz R, Thüroff J, SRR W. Hrsg Kinderurologie in Klinik und Praxis. Thieme; 2012: 332
- 5 Braga LH, D'Cruz J, Rickard M. et al. The Fate of Primary Nonrefluxing Megaureter: A Prospective Outcome Analysis of the Rate of Urinary Tract Infections, Surgical Indications and Time to Resolution. Journal of Urology 2016; 195: 1300-1305
- 6 Braga LH, McGrath M, Arora S. et al. A superiority, parallel, blinded randomized, placebo controlled trial of continuous antibiotic prophylaxis for febrile UTIs in infants with prenatal hydronephrosis: The ALPHA study. In, ESPU congress. Lyon 2019
- 7 Braga LH, McGrath M, Lorenzo AJ. et al. Revisiting risk factors for febrile urinary tract infection using a large prenatal hydronephrosis dataset. In, AUA Congress 2019. Chicago 2019
- 8 Braga LH, Mijovic H, Farrokhyar F. et al. Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis. Pediatrics 2013; 131: e251-e261
- 9 Caiulo VA, Caiulo S, Gargasole C. et al. Ultrasound mass screening for congenital anomalies of the kidney and urinary tract. Pediatr Nephrol 2012; 27: 949-953
- 10 Calderon-Margalit R, Golan E, Twig G. et al. History of Childhood Kidney Disease and Risk of Adult End-Stage Renal Disease. N Engl J Med 2018; 378: 428-438
- 11 Castagnetti M, Cimador M, Esposito C. et al. Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele. Nat Rev Urol 2012; 9: 321-329
- 12 Cheng CH, Tsai MH, Huang YC. et al. Antibiotic resistance patterns of community-acquired urinary tract infections in children with vesicoureteral reflux receiving prophylactic antibiotic therapy. Pediatrics 2008; 122: 1212-1217
- 13 Coelho GM, Bouzada MC, Lemos GS. et al. Risk factors for urinary tract infection in children with prenatal renal pelvic dilatation. Journal of Urology 2008; 179: 284-289
- 14 Conway PH, Cnaan A, Zaoutis T. et al. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 2007; 298: 179-186
- 15 Core Team R (2014) R: a language and environment for statistical computing. R Foundation for Statistical Computing V; Austria: https://www.R-project.org
- 16 Coulthard MG, Lambert HJ, Keir MJ. Occurrence of renal scars in children after their first referral for urinary tract infection. BMJ 1997; 315: 918-919
- 17 Craig JC, Simpson JM, Williams GJ. et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 2009; 361: 1748-1759
- 18 Dekirmendjian A, Braga LH. Primary Non-refluxing Megaureter: Analysis of Risk Factors for Spontaneous Resolution and Surgical Intervention. Front Pediatr 2019; 7: 126
- 19 DiRenzo D, Persico A, DiNicola M. et al. Conservative management of primary non-refluxing megaureter during the first year of life: A longitudinal observational study. Journal of pediatric urology 2015; 11: 226.e221-226
- 20 Farrugia MK, Hitchcock R, Radford A. et al. British Association of Paediatric Urologists consensus statement on the management of the primary obstructive megaureter. J Pediatr Urol 2014; 10: 26-33
- 21 Frimberger D, Mercado-Deane MG, Section On U. et al. Establishing a Standard Protocol for the Voiding Cystourethrography. Pediatrics 2016; 138(5): e20162590
- 22 Gordon I, Piepsz A, Sixt R. et al. Guidelines for standard and diuretic renogram in children. Eur J Nucl Med Mol Imaging 2011; 38: 1175-1188
- 23 Grimes DA, Schulz KF. Cohort studies: marching towards outcomes. Lancet 2002; 359: 341-345
- 24 Hellstrom A, Hanson E, Hansson S. et al. Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Child 1991; 66: 232-234
- 25 Hewitt IK, Pennesi M, Morello W. et al. Antibiotic Prophylaxis for Urinary Tract Infection-Related Renal Scarring: A Systematic Review. Pediatrics 2017; 139(5): e20163145
- 26 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558
- 27 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
- 28 Jones RA, Perez-Brayfield MR, Kirsch AJ. et al. Renal transit time with MR urography in children. Radiology 2004; 233: 41-50
- 29 Laupacis A, Wells G, Richardson WS. et al. Usersʼ guides to the medical literature. V. How to use an article about prognosis. Evidence-Based Medicine Working Group. JAMA 1994; 272: 234-237
- 30 Lee JH, Choi HS, Kim JK. et al. Nonrefluxing neonatal hydronephrosis and the risk of urinary tract infection. Journal of Urology 2008; 179: 1524-1528
- 31 Marild S, Jodal U. Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr 1998; 87: 549-552
- 32 Mendes D, Alves C, Batel-Marques F. Number needed to treat (NNT) in clinical literature: an appraisal. BMC Med 2017; 15: 112
- 33 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
- 34 Mollard P, Bonnet JP, Vautherin R. Primary obstructive megaureter without reflux in neonates. Annales de Pediatrie 1995; 42: 249-255
- 35 Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med 2011; 365: 239-250
- 36 Morris BJ, Wiswell TE. Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis. J Urol 2013; 189: 2118-2124
- 37 Mulder RL, van Dalen EC, Van den Hof M. et al. Hepatic late adverse effects after antineoplastic treatment for childhood cancer. Cochrane Database Syst Rev 2011; DOI: 10.1002/14651858.CD008205.pub2. CD008205
- 38 Nagy V, Baca M, Boor A. Primary obstructed megaureter (POM) in children. Bratisl Lek Listy 2013; 114: 650-656
- 39 Nguyen HT, Benson CB, Bromley B. et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 2014; 10: 982-998
- 40 Ranawaka R, Hennayake S. Resolution of primary non-refluxing megaureter: an observational study. Journal of Pediatric Surgery 2013; 48: 380-383
- 41 Renda R. Renal outcome of congenital anomalies of the kidney and urinary tract system: a single-center retrospective study. Minerva Urologica e Nefrologica 2018; 70: 218-225
- 42 Roth CC, Hubanks JM, Bright BC. et al. Occurrence of urinary tract infection in children with significant upper urinary tract obstruction. Urology 2009; 73: 74-78
- 43 Rubenwolf P, Herrmann-Nuber J, Schreckenberger M. et al. Primary non-refluxive megaureter in children: single-center experience and follow-up of 212 patients. International Urology & Nephrology 2016; 48: 1743-1749
- 44 Schulz KF, Chalmers I, Hayes RJ. et al. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995; 273: 408-412
- 45 Selekman RE, Shapiro DJ, Boscardin J. et al. Uropathogen Resistance and Antibiotic Prophylaxis: A Meta-analysis. Pediatrics 2018; 142(1): e20180119
- 46 Shukla AR, Cooper J, Patel RP. et al. Prenatally detected primary megaureter: a role for extended followup. Journal of Urology 2005; 173: 1353-1356
- 47 Sinha A, Bagga A, Krishna A. et al. Revised guidelines on management of antenatal hydronephrosis. Indian J Nephrol 2013; 23: 83-97
- 48 Song SH, Lee SB, Park YS. et al. Is antibiotic prophylaxis necessary in infants with obstructive hydronephrosis?. Journal of Urology 2007; 177: 1098-1101
- 49 Stijnen T, Hamza TH, Ozdemir P. Random effects meta-analysis of event outcome in the framework of the generalized linear mixed model with applications in sparse data. Stat Med 2010; 29: 3046-3067
- 50 Stratton KL, Pope JCt, Adams MC. et al. Implications of ionizing radiation in the pediatric urology patient. J Urol 2010; 183: 2137-2142
- 51 Subcommittee on Urinary Tract Infection SCoQI, Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011; 128: 595-610
- 52 Vidal V, Fremond B, Chapuis M. et al. Primary obstructive megaureter in infants: medical or surgical treatment? Apropos of 24 cases. J Urol (Paris) 1988; 94: 279-283
- 53 Visuri S, Jahnukainen T, Taskinen S. Incidence of urinary tract infections in infants with antenatally diagnosed hydronephrosis – A retrospective single center study. Journal of Pediatric Surgery 2017; 52: 1503-1506
- 54 Whiting P, Westwood M, Watt I. et al. Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr 2005; 5: 4
- 55 Williams G, Hodson EM, Craig JC. Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev 2019; 2: CD001532
- 56 Williams GJ, Craig JC, Carapetis JR. Preventing urinary tract infections in early childhood. Adv Exp Med Biol 2013; 764: 211-218
- 57 Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int 2002; 89: 149-156
- 58 Zampieri N, Zamboni C, Camoglio FS. Clinical course of grade I-III megaureters detected on prenatal ultrasound. Minerva Pediatr 2011; 63: 439-443