Urinary Tract Infection after Robot-Assisted Laparoscopic Pyeloplasty: Are Urine Cultures and Antibiotics Helpful?

To evaluate how variations in peri-operative urine culture (UCx) and antibiotic prophylaxis utilization following robot assisted laparoscopic pyeloplasty (RALP) affect post-RALP urinary tract infection (UTI) rates in children, then use data to generate a standardized care pathway.

Patients undergoing RALP at a single institution from January 2014-October 2018 were retrospectively reviewed. Patients with vesicoureteral reflux, neurogenic bladder, intermittent catheterization, <=2 months follow-up after stent removal, or age >=18 years were excluded. UCx use, UCx results, and pre- and post-RALP antibiotic use were recorded. The primary outcome was symptomatic UTI, tracked until 60 days after stent removal. UTI was defined as presence of fever or urinary symptoms, a positive UCx with >=10,000 colony forming units of one uropathogen, and a positive urinalysis.

152 patients were included (72% male [73% circumcised], 61% white, 23% Hispanic). One underwent a re-operative pyeloplasty, yielding 153 encounters. Eight patients (5.2%; 95% CI 1.7-8.7%) developed post-RALP UTI. Uncircumcised status and use of pre-operative prophylactic antibiotics were associated with post-RALP UTI (p=0.03 and p<0.01, respectively). Use of post-RALP antibiotics, whether prophylactic or therapeutic, was not associated with lower UTI rates (p=0.92). Positive pre-RALP UCx and positive intra-operative stent removal UCx were associated with higher UTI rates (p=0.03 and p<0.01, respectively).

UTI occurred in 5.2% of our cohort of >150 patients. As post-RALP antibiotic use was not associated with lower UTI rates, prophylactic antibiotics may be reserved for patients with risk factors. A standardized care pathway could safely reduce unnecessary utilization of UA/UCx and antibiotics.

Urology. 2020 Nov 25 [Epub ahead of print]

Yvonne Y Chan, Ilina Rosoklija, Rachel Shannon, Ashima Singal, Anthony D'Oro, Patrick Meade, Edward M Gong, Bruce W Lindgren, Emilie K Johnson

Department of Urology, Northwestern University Feinberg School of Medicine; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: ., Department of Urology, Northwestern University; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: ., Department of Urology, Northwestern University; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: ., Department of Urology, Northwestern University; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: ., Department of Urology, Northwestern University; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: ., Department of Urology, Northwestern University; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: ., Department of Urology, Northwestern University; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: ., Department of Urology, Northwestern University; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: ., Department of Urology, Northwestern University; Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Electronic address: .

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