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Klin Padiatr 2022; 234(01): 5-13
DOI: 10.1055/a-1303-4695
Review

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
Katharina Rohner 
1   Pediatric Nephrology, University Children’s Hospital Zürich, Zurich, Switzerland
,
Sara Mazzi
1   Pediatric Nephrology, University Children’s Hospital Zürich, Zurich, Switzerland
,
Kathrin Buder
1   Pediatric Nephrology, University Children’s Hospital Zürich, Zurich, Switzerland
,
Marcus Weitz
2   Pediatric Nephrology, University Children’s Hospital Tübingen, Tuebingen, Germany
› Author Affiliations Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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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 infection

Schlüsselwörter

antibiotische Prophylaxe - Obstruktion - Primärer nicht refluxiver Megaureter - Ureterdilatation - Harnwegsinfektion

Supplementary Material



Publication History

Article published online:
17 December 2020

© 2020. Thieme. All rights reserved.

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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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 Baskin LS, Zderic SA, Snyder HM. et al. Primary dilated megaureter: long-term followup. Journal of Urology 1994; 152: 618-621
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMed
  • 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
    PubMed
  • 8 Braga LH, Mijovic H, Farrokhyar F. et al. Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis. Pediatrics 2013; 131: e251-e261
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 18 Dekirmendjian A, Braga LH. Primary Non-refluxing Megaureter: Analysis of Risk Factors for Spontaneous Resolution and Surgical Intervention. Front Pediatr 2019; 7: 126
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 21 Frimberger D, Mercado-Deane MG, Section On U. et al. Establishing a Standard Protocol for the Voiding Cystourethrography. Pediatrics 2016; 138(5): e20162590
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 23 Grimes DA, Schulz KF. Cohort studies: marching towards outcomes. Lancet 2002; 359: 341-345
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 26 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558
    CrossrefPubMedGoogle Scholar
  • 27 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
    CrossrefPubMedGoogle Scholar
  • 28 Jones RA, Perez-Brayfield MR, Kirsch AJ. et al. Renal transit time with MR urography in children. Radiology 2004; 233: 41-50
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 32 Mendes D, Alves C, Batel-Marques F. Number needed to treat (NNT) in clinical literature: an appraisal. BMC Med 2017; 15: 112
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 34 Mollard P, Bonnet JP, Vautherin R. Primary obstructive megaureter without reflux in neonates. Annales de Pediatrie 1995; 42: 249-255
    PubMedGoogle Scholar
  • 35 Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med 2011; 365: 239-250
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 38 Nagy V, Baca M, Boor A. Primary obstructed megaureter (POM) in children. Bratisl Lek Listy 2013; 114: 650-656
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 40 Ranawaka R, Hennayake S. Resolution of primary non-refluxing megaureter: an observational study. Journal of Pediatric Surgery 2013; 48: 380-383
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 45 Selekman RE, Shapiro DJ, Boscardin J. et al. Uropathogen Resistance and Antibiotic Prophylaxis: A Meta-analysis. Pediatrics 2018; 142(1): e20180119
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 47 Sinha A, Bagga A, Krishna A. et al. Revised guidelines on management of antenatal hydronephrosis. Indian J Nephrol 2013; 23: 83-97
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 50 Stratton KL, Pope JCt, Adams MC. et al. Implications of ionizing radiation in the pediatric urology patient. J Urol 2010; 183: 2137-2142
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 55 Williams G, Hodson EM, Craig JC. Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev 2019; 2: CD001532
    PubMedGoogle Scholar
  • 56 Williams GJ, Craig JC, Carapetis JR. Preventing urinary tract infections in early childhood. Adv Exp Med Biol 2013; 764: 211-218
    CrossrefPubMedGoogle Scholar
  • 57 Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int 2002; 89: 149-156
    CrossrefPubMedGoogle Scholar
  • 58 Zampieri N, Zamboni C, Camoglio FS. Clinical course of grade I-III megaureters detected on prenatal ultrasound. Minerva Pediatr 2011; 63: 439-443
    PubMedGoogle Scholar