Incidence of Urinary Tract Infections in Newborns with Spina Bifida: Is Antibiotic Prophylaxis Necessary?

Details

• Alternative Title:
  J Urol
• Personal Author:
  Wallis, M Chad ; Paramsothy, Pangaja ; Newsome, Kimberly ; Williams, Tonya ; Routh, Jonathan C ; Joseph, David B ; Cheng, Earl ; Tu, Duong ; Austin, J Chris ; Tanaka, Stacy T ; Walker, William O ; Smith, Kathryn A ; Baum, Michelle A ; Wiener, John S
• Description:
  PURPOSE:
  
  Urinary tract infections (UTI) commonly occur in patients with spina bifida (SB) and pose a risk for renal scarring. Routine antibiotic prophylaxis has been utilized in newborns with SB to prevent UTI. We hypothesized that prophylaxis can safely be withheld in newborns with SB until clinical assessment allows for risk stratification.
  
  MATERIALS AND METHODS:
  
  Newborns with myelomeningocele at nine institutions were prospectively enrolled in the UMPIRE study and managed by a standardized protocol with a strict definition for UTI. Patient data were collected regarding details of reported UTI, baseline renal ultrasound findings, vesicoureteral reflux, use of clean intermittent catheterization (CIC), and circumcision status in boys. Risk Ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated using log-binomial models.
  
  RESULTS:
  
  From 2/2015 through 8/2019, data were available on 299 newborns (50.5% male). During the first four months of life, 48 (16.1%) newborns were treated for UTI with 23 (7.7%) having positive cultures; however, only 12 (4.0%) met the strict UTI definition. Infants with grade 3–4 hydronephrosis had an increased risk of UTI compared to infants with no hydronephrosis (RR=10.1; 95%CI=2.8, 36.3). Infants on CIC also had an increased risk of UTI (RR=3.3; 95%CI=1.0, 10.5).
  
  CONCLUSIONS:
  
  The incidence of a culture-positive, symptomatic UTI among newborns with SB in the first 4 months of life was low. Patients with high grades of hydronephrosis or those on CIC had a significantly greater incidence of UTI. Our findings suggest that routine antibiotic prophylaxis may not be necessary for most newborns with SB.
  
  
• Subjects:
  Antibiotic Prophylaxis Article Female Humans Incidence Infant Infant, Newborn Male Meningomyelocele Newborn Prospective Studies Spina Bifida Spinal Dysraphism Urinary Tract Infection Urinary Tract Infections

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• Source:
  J Urol. 206(1):126-132
• Pubmed ID:
  33683941
• Pubmed Central ID:
  PMC8268042
• Document Type:
  Journal Article
• Funding:
  U01DD001092/ACL/ACL HHSUnited States/ ; U01DD001068/ACL/ACL HHSUnited States/ ; U01 DD001075/DD/NCBDD CDC HHSUnited States/ ; U01DD001075/ACL/ACL HHSUnited States/ ; U01 DD001060/DD/NCBDD CDC HHSUnited States/ ; U01DD001070/ACL/ACL HHSUnited States/ ; U01 DD001092/DD/NCBDD CDC HHSUnited States/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/ ; U01DD001060/ACL/ACL HHSUnited States/ ; U01DD001058/ACL/ACL HHSUnited States/ ; U01DD001064/ACL/ACL HHSUnited States/ ; U01 DD001263/DD/NCBDD CDC HHSUnited States/ ; U01 DD001087/DD/NCBDD CDC HHSUnited States/ ; U01 DD001058/DD/NCBDD CDC HHSUnited States/ ; U01 DD001276/DD/NCBDD CDC HHSUnited States/ ; U01 DD001284/DD/NCBDD CDC HHSUnited States/ ; U01 DD001064/DD/NCBDD CDC HHSUnited States/ ; U01 DD001079/DD/NCBDD CDC HHSUnited States/ ; U01 DD001068/DD/NCBDD CDC HHSUnited States/ ; U01DD001079/ACL/ACL HHSUnited States/ ; U01DD001087/ACL/ACL HHSUnited States/ ; U01 DD001070/DD/NCBDD CDC HHSUnited States/
• Volume:
  206
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:987190626b78015c97aa5297cb95059c157d53165e37373bd7bbe76bd08daaf3
• Download URL:
  https://stacks.cdc.gov/view/cdc/107892/cdc_107892_DS1.pdf
• File Type:
  [PDF - 74.51 KB ]