PROPHYLACTIC ANTIBIOTIC USE IN

PEDIATRIC PATIENTS UNDERGOING

URINARY TRACT
CHATETERIZATION: A SURVEY OF
MEMBERS OF THE SOCIETY FOR
PEDIATRIC UROLOGY

Presentator: dr. Yudhi Leo Prima

Preceptor: Dr. dr. Yevri Zulfiqar, Sp.B,
Sp.U
BACKGROUND

• ↑ Length of stay
• Penalty from Medical
Nosocomial Aid Services
Infection • ↑ Morbidity
• ↑ Mortality The Use of
Antibiotics
in Pediatric
Population
• Antibiotic Resistance
• Lack of Antibiotic
Antibiotic Development
Use • Lack of Applicable
Guidelines
First Step
in Solving
Problem

Describe
Current
Practice
METHOD

Questionnaire

Demographic Specific

154/484 % (34%)
RESULT
Table 1 Respondent Demographics

Questions Responses (%) Questions Responses (%)

Age (years) Years in
31–40 35 (23%) practice 6 (4%)
41–50 42 (27%) Currently in
51–60 51 (33%) fellowship 29 (19%)
> 60 25 (16%) 0–5 23 (15%)
6–10 23 (15%)
Gender 11–15 21 (14%)
Male 116 (75%) 16–20 51 (33%)
Female 34 (22%) > 20
Other 2 (1.3%) Number of
Fellowship Pediatric
Trained Urologists in
Currently in 6 (4%) Practice
fellowship 134 (87%) 1-2 57 (37%)
Yes 11 (7%) 3-4 51 (33%)
No 5-6 28 (18%)
7-10 15 (9.7%)
>10 3 (1.9%)
RESULT

Table 1 Respondent Demographics

Questions Responses (%) Questions Respon
Practice Setting ses (%)
Academic setting 102 (66%) AUA Section
Hospital employee 17 (11%) Mid Atlantic 16 (10%)
Private 34 (22%) New England 6 (4%)
Other 1 (0.6%) New York 9 (6%)
North Central 38 (25%)
Northeastern 9 (6%)
South Central 20 (13%)
Southeastern 24 (16%)
Western 29 (19%)
Other 3 (2%)
PERSONAL EXPERIENCE WITH INFECTIOUS
COMPLICATIONS

 Twenty-five percent of respondents reported

having a patient with a serious complication
(requiring an intensive care unit or an invasive
procedure) or death related to a CAUTI.
 Thirty-one percent of these respondents reporting
changing their practice based on this event, while
 59% reported not changing their practice based
on this event, and
 10% reported being unsure if their practice
changed based on this event.
ASSOCIATIONS

 Urologists > 50 years of age and fellowship-trained

urologists were more likely to prescribe antibiotics > 50% of
the time for hypospadias stents
 Respondents who reported changing practice patterns
based on a serious complication or death related to CAUTI
were more likely to prescribe antibiotics >50% of the time
with a ureteral double-J stent and for the entire time the
catheter is in place for Case Scenario #2
 There was also a possible association noted for respondents
who reported changing practice patterns based on an
infectious complication to prescribe antibiotics > 50% of the
time with a SPC, but this was not statistically significant.
 There was no difference in prescribing pattern based on
gender, size of practice, practice setting, or AUA section.
DISCUSSION
 80% prescribe AB for hypospadias stent  clear
consensus and more literature data (Meir et al
2004, “decreased risk of UTI and suggest (non
significant urethrocutanous fistula formation”
 Scenario #3 the decisions were split into 3: no
AB, at removal, entire time  complexity of
patients and lack of evidence of AB use.
 Changing practices based on complication
experience  Bias from prior adverse event and
lack of evidence of AB use
RELATED STUDIES
 Wazait et al : use of AB at the time of cath
removal in adult
 Wide variety of pre operative AB prophylactic use

60%

40%
 Limited and inconsistent evidence of decreased
risk of UTI in prophylactic AB use at the time of
cath removal for adult let alone pediatric
population
REGULATION
The AUA Best Practice Policy, Statement on
Urologic Surgery Antimicrobial Prophylaxis :
“Antibiotic prophylaxis for removal of external
urinary catheters and for urodynamics if risk
factors such as urinary anatomic abnormalities,
immunodeficiency, externalized catheters,
colonized exogenous or endogenous material, and
prolonged hospitalization are present”

Statement was based on adult and post-

prostatectomy literature  less applicable for
pediatric population
Finally, the United States Healthcare Infection
Control Practices Advisory Committee, a division of
the Centers for Disease Control and Prevention,
also does not recommend routine antibiotics with
short- and longterm catheterization, but does make
a specific exception for patients with bacteriuria
upon catheter removal following urologic surgery
NEGATIVITY
 Only 1/3 were responded and only included SPU
members  similar rate for other survey
 Questions about specific AB were not asked

 AB resistance patterns should be different in

different geographic distribution, instead no
difference prescribing pattern.
 No conclusion solving the problem of prophylactic
AB use in pediatric population  is not the
purpose of this study
CONCLUSION
 Further study needed