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01-09-2018 | Original Article

Impact of positive preoperative urine cultures before pediatric lower urinary tract reconstructive surgery

Authors: Alexander C. Small, Alejandra Perez, Jayant Radhakrishnan, Stanley Desire, Philip Zachariah, Lisa C. Creelman, Shumyle Alam

Published in: Pediatric Surgery International | Issue 9/2018

Abstract

Purpose

Children who undergo lower urinary tract reconstruction (LUTR) often have asymptomatic bacteriuria or recurrent urinary tract infections (UTI). We aimed to determine the prevalence of positive preoperative urine cultures (PPUC) before LUTR and to analyze any impact on postoperative outcomes.

Methods

This retrospective review included all pediatric LUTR procedures utilizing bowel segments performed by one surgeon over 2 years. Preoperative cultures were obtained 1–2 days before surgery. Baseline characteristics and 90-day infection/readmission rates between patients with and without PPUC were compared using descriptive statistics, Fisher’s exact, and Mann–Whitney tests with significance p < 0.05.

Results

54 patients with mean age 10.1 ± 5.6 years underwent LUTR procedures using bowel including continent catheterizable channel (85%), enterocystoplasty (81%), and/or urinary diversion (9%). PPUC was present in 28 patients (52%). Postoperatively, 20% had inpatient infections, including eight UTI, four surgical site infections, and two bloodstream infections with no difference between those with or without PPUC. Within 90 days of discharge, 28% of patients were readmitted to the hospital, and there was no difference between groups. Postoperative urine cultures were positive in 83% of patients within 90 days.

Conclusions

Half of the patients undergoing LUTR have PPUC, but it does not increase the risk of postoperative infections or hospital readmissions. We believe complex LUTR can be safely performed in patients with PPUC.

Pokrzywa CJ, Papageorge CM, Kennedy GD (2016) Preoperative urinary tract infection increases postoperative morbidity. J Surg Res 205:213–220. https://doi.org/10.1016/j.jss.2016.06.025 CrossRefPubMed

Fok CS, McKinley K, Mueller ER et al (2013) Day of surgery urine cultures identify urogynecologic patients at increased risk for postoperative urinary tract infection. J Urol 189:1721–1724. https://doi.org/10.1016/j.juro.2012.11.167 CrossRefPubMed

Patel N, Shi W, Liss M et al (2015) Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications. J Endourol 29:531–536. https://doi.org/10.1089/end.2014.0776 CrossRefPubMed

Koulouvaris P, Sculco P, Finerty E et al (2009) Relationship between perioperative urinary tract infection and deep infection after joint arthroplasty. Clin Orthop Relat Res 467:1859–1867. https://doi.org/10.1007/s11999-008-0614-8 CrossRefPubMed

Rizvi SJ, Chauhan R, Gupta R, Modi P (2008) Significance of pretransplant urinary tract infection in short-term renal allograft function and survival. Transplant Proc 40:1117–1118. https://doi.org/10.1016/j.transproceed.2008.03.075 CrossRefPubMed

Cai T, Verze P, Palmieri A et al (2017) Is preoperative assessment and treatment of asymptomatic bacteriuria necessary for reducing the risk of postoperative symptomatic urinary tract infections after urologic surgical procedures? Urology 99:100–105. https://doi.org/10.1016/j.urology.2016.10.016 CrossRefPubMed

Vigil HR, Hickling DR (2016) Urinary tract infection in the neurogenic bladder. Transl Androl Urol 5:72–87. https://doi.org/10.3978/j.issn.2223-4683.2016.01.06 PubMedPubMedCentralCrossRef

McLeod DJ, Asti L, Mahida JB et al (2016) Preoperative risk assessment in children undergoing major urologic surgery. J Pediatr Urol 12:26.e1–26.e7. https://doi.org/10.1016/j.jpurol.2015.04.044 CrossRef

Cohen S, Palazzi K, Marietti S et al (2014) Lack of improvement: a national assessment of readmission rates after pediatric bladder reconstruction. Nephrourol Mon 6:e20263. https://doi.org/10.5812/numonthly.20263 CrossRefPubMedPubMedCentral

10.

Bilimoria KY, Liu Y, Paruch JL et al (2013) Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 217:833–842. https://doi.org/10.1016/j.jamcollsurg.2013.07.385 CrossRefPubMedPubMedCentral

11.

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

12.

Korets R, Graversen JA, Kates M et al (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186:1899–1903. https://doi.org/10.1016/j.juro.2011.06.064 CrossRefPubMed

13.

Novak TE, Salmasi AH, Mathews RI et al (2008) Complications of complex lower urinary tract reconstruction in patients with neurogenic versus nonneurogenic bladder—is there a difference? J Urol 180:2629–2634. https://doi.org/10.1016/j.juro.2008.08.056 CrossRefPubMed

14.

Du K, Mulroy EE, Wallis MC et al (2015) Enterocystoplasty 30-day outcomes from National Surgical Quality Improvement Program Pediatric 2012. J Pediatr Surg 50:1535–1539. https://doi.org/10.1016/j.jpedsurg.2015.04.009 CrossRefPubMed

15.

McNamara ER, Kurtz MP, Schaeffer AJ et al (2015) 30-Day morbidity after augmentation enterocystoplasty and appendicovesicostomy: a NSQIP pediatric analysis. J Pediatr Urol 11:209.e1–209.e6. https://doi.org/10.1016/j.jpurol.2015.04.016 CrossRef

16.

Regenbogen SE, Read TE, Roberts PL et al (2011) Urinary tract infection after colon and rectal resections: more common than predicted by risk-adjustment models. J Am Coll Surg 213:784–792. https://doi.org/10.1016/j.jamcollsurg.2011.08.013 CrossRefPubMed

Title: Impact of positive preoperative urine cultures before pediatric lower urinary tract reconstructive surgery
Authors: Alexander C. Small
Alejandra Perez
Jayant Radhakrishnan
Stanley Desire
Philip Zachariah
Lisa C. Creelman
Shumyle Alam
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 9/2018
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-018-4306-5

At a glance: The STEP trials

Springer Medicine

Impact of positive preoperative urine cultures before pediatric lower urinary tract reconstructive surgery

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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