Febrile Urinary Tract Infections in Children with Primary Non-Refluxing Megaureter: A Systematic Review and Meta-Analysis

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

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