475 - Antibiotic Prophylaxis and Risk of Urinary Tract Infections Following Radiological Studies That Require Urinary Catheterization in Children <5 Years

Publication Number: 2463.475

Ruvini G. Jayawardena, Children's Hospital of Michigan, Detroit, MI, United States; Rossana Baracco, Children’s hospital of Michigan, Detroit, MI, United States; Cansu K. Ensert Cihan, Children's Hospital of Michigan, Royal Oak, MI, United States; Melissa Gregory, Central Michigan University College of Medicine, Detroit, MI, United States; Manpreet Grewal, Children's hospital of Michigan, Detroit, MI, United States; Amrish Jain, Children's Hospital of Michigan, Detroit, MI, United States; Gaurav Kapur, Central Michigan University, DETROIT, MI, United States; Mary Najjar, Children's Hospital of Michigan, Sterling heights, MI, United States; Wael M. Abukwaik, Children Hospital of Michigan, Detroit, MI, United States

Background: Risk of urinary tract infection (UTI) after radiological studies that require urinary catheterization such as voiding cystourethrogram (VCUG), and mercaptuacetyltriglycine (MAG3) scan is variable. Due to paucity of clinical evidence, use of antibiotic prophylaxis prior to these is controversial and guided by physician preference.

Objective: The study aims to investigate the risk of catheter induced UTI in relation to antibiotic prophylaxis after radiological studies that require urinary catheterization at Children's hospital of Michigan, Detroit from July 2019 to June 2024

Design/Methods: Included in the retrospective study were children < 5years who underwent at least one radiological study needing urinary catheterization. Children who catheterize routinely and those who did not follow up after radiological studies were excluded. Data collection was done via chart review through the EMR. Patients were identified using test codes for VCUG, and MAG3. We used SAS (version 9.4) for statistical analysis. Catheterization related acute UTI were defined as positive urine culture >100,000 cfu/ml for a single organism in an appropriately collected sample that occurred within four weeks of the study.

Results: Total of 604 children were included, with 64% being female and 32% being Caucasians. The most frequent imaging study which required catheterization was VCUG, and 44% of them were done at the age of 3 months to 12 months. Majority (67%) of the total study population was on antibiotic prophylaxis. The most frequent indication (63%) for imaging study was first febrile UTI with or without ultrasound abnormalities, and 74% of them were on antibiotic prophylaxis prior to the study. Among 604 patients, only 8 (1.3%) had catheterization associated acute UTI and 87% (7/8) urine cultures grew Escherichia coli and 5 out of 6 (83%) of them were resistant to the antibiotic prophylaxis which the patient was on. Of note 7 out of 8 (87%) patients who had UTI post study were diagnosed to have Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) which includes hydronephrosis and vesicoureteral reflux.

Conclusion(s): Patients with CAKUT are at a higher risk to develop acute UTI after imaging studies requiring catheterization and may benefit from antibiotic prophylaxis. Overall the risk for UTI is minimal from catheterization required for imaging studies.

Figure1
MAG-3: technetium-99m mercaptuacetyltriglycine scan; UTI: Urinary tract infection; VCUG: Voiding cystourethrogram

Table 1: Frequency distribution of demographics and indications for urinary prophylaxis of imaging studies needing urinary catheterization.
MAG3: technetium-99m mercaptuacetyltriglycine; US: ultrasound; UTI: urinary tract infection; VCUG: voiding cystourethrogram;
This group of patients had undergone both studies at the same time or separately.