Login to Access Video or Poster Abstract: MP61-01
Sources of Funding: None

Introduction

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._x000D_

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._x000D_

Funding

None