MP61-01 IMPACT OF POSITIVE PREOPERATIVE URINE CULTURES BEFORE PEDIATRIC LOWER URINARY TRACT RECONSTRUCTIVE SURGERY UTILIZING BOWEL

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2017MP61-01 IMPACT OF POSITIVE PREOPERATIVE URINE CULTURES BEFORE PEDIATRIC LOWER URINARY TRACT RECONSTRUCTIVE SURGERY UTILIZING BOWEL Alexander C Small, Alejandra Perez, Stanley Desire, Michael J Lipsky, Justin T Matulay, Lisa Creelman, Pasquale Casale, and Shumyle Alam Alexander C SmallAlexander C Small More articles by this author , Alejandra PerezAlejandra Perez More articles by this author , Stanley DesireStanley Desire More articles by this author , Michael J LipskyMichael J Lipsky More articles by this author , Justin T MatulayJustin T Matulay More articles by this author , Lisa CreelmanLisa Creelman More articles by this author , Pasquale CasalePasquale Casale More articles by this author , and Shumyle AlamShumyle Alam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1859AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preoperative urinary tract infections (UTIs) have been shown to correlate with postoperative complications including sepsis, surgical site infections (SSI), and kidney failure. Children who undergo lower urinary tract reconstruction (LUTR) for congenital malformations or neurogenic bladder often have asymptomatic bacteriuria due to chronic colonization. We studied the prevalence and impact of positive preoperative urine cultures (PPUC) before pediatric LUTR. METHODS We retrospectively reviewed all pediatric LUTR procedures utilizing bowel segments performed by a single surgeon from 2/2014 to 7/2016. Preoperative urine cultures were analyzed 1-2 days before surgery. Baseline characteristics and 90-day infection/readmission rates were compared between patients with and without PPUC. Fischer's exact, Mann-Whitney, and univariate logistic regression analyses were performed to compare groups with significance p<0.05. RESULTS Overall, 54 patients underwent LUTR (including 85% catheterizable channel, 56% bladder augmentation and 9% continent diversion with concurrent 54% ureteral reimplantation and 37% bladder neck reconstruction/division). Mean age was 10±6 years. None were symptomatic. All started antibiotics at the time of surgery and continued while inpatient. The most common isolated organisms were Enterococcus (n=8), E. coli (n=7), Pseudomonas (n=4), and Klebsiella (n=4). Postoperatively, 20% of the cohort had inpatient infections (8 urine, 4 wound, 2 blood). Infection rates did not differ between groups (9% PPUC vs. 11% negative culture, p=0.69). Median length of stay was also the same in both groups (11 days, p=0.96). Within 90 days of discharge, 27% of patients were readmitted (11% PPUC vs. 16% negative, OR 1.83, p=0.32), 18% experienced a symptomatic UTI (7% PPUC vs. 11% negative, OR 0.58, p=0.45), and 4% developed SSI (2% PPUC vs. 2% negative, OR=0.96, p=0.96). Two patients experienced major complications requiring re-operation (bowel obstruction and ureteral obstruction) and both had negative preoperative urine cultures. CONCLUSIONS There is a high prevalence of PPUC in patients presenting for LUTR with bowel segments, but this factor did not appear to impact postoperative infection risk or hospital readmissions. This study supports the safety of performing complex LUTR in patients with PPUC and may provide rationale for the use of broad-spectrum perioperative antibiotics. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e798 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Alexander C Small More articles by this author Alejandra Perez More articles by this author Stanley Desire More articles by this author Michael J Lipsky More articles by this author Justin T Matulay More articles by this author Lisa Creelman More articles by this author Pasquale Casale More articles by this author Shumyle Alam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...