Prevention of UTI in Children with CAKUT: A Medical Challenge
Context: Inflammation of the urinary tract (UTI) is more common in children with congenital kidney and urinary tract (CAKUT) anomalies than in the general paediatric population. Children may be predisposed to renal scarring, hypertension and CKD due to repeated UTI as a result of CAKUT. In this group of patients, UTI avoidance is advocated, but in light of the controversy surrounding the use of prophylactic antibiotics, achieving this has become a medical challenge.
Methods: This was a 10-year retrospective study of children with CAKUT who were put at the Academic Hospital in Johannesburg on prophylactic antibiotics for a certain period of time. UTI rates, isolated types of causative species and the effectiveness of prophylactic antibiotics in the prevention of UTI have been reported.
Results: We examined one hundred and thirty four (134) patients with CAKUT. Thirty-six (36) of them were started on prophylactic antibiotics after CAKUT was diagnosed. The relation between the use of prophylactic antibiotics and the incidence of UTI was statistically significant (p < 0.001). Patients that were not on prophylactic antibiotics were five times more likely than those on prophylactic antibiotics to have a UTI (OR = 5.21, P = 0.001, 95% CI: 1.9906-13.6277). An altered pattern of isolated bacteria was seen by patients who were on prophylactic antibiotics, with Klebsiella pneumoniae being the most frequently isolated organism rather than E. Compared with the community that were not on prophylactic antibiotics, coli. The relation between the form of bacteria isolated and the use of antibiotic prophylaxis (p= 0.031) was statistically important. Conclusion: In our cohort of patients with CAKUT, antibiotic prophylaxis was very successful in decreasing the incidence of UTI.
Dr. Nneka Chioma Okoronkwo
The Renal Unit, Department of Paediatrics, Abia State University Teaching Hospital, Aba, Nigeria.
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