Risk factors associated to urinary infection in patients with high grade antenatal hydronephrosis

Abstract

Introduction: The high incidence of urinary infection in patients with high-grade antenatal hydronephrosis has led us to recommend antibiotic prophylaxis. Objectives: To determine the incidence of urinary infection in patients with high grade isolated antenatal hydronephrosis and its possible associated risk factors. Methods: Observational retrospective analytic design. Inclusion criteria: new born with isolated high grade antenatal hydronephrosis (moderate and severe, anterior-posterior pelvis diameter >15mm) monitored for more than 12 months, conservatively treated until surgical intervention on those that required it. New born with high-grade hydronephrosis due to vesicoureteral reflux, megaureters, posterior urethral valve, ureterocele, were not included. Multiple logistic regression analyses were performed, independent variables: gender, grade of hydronephrosis and antibiotic prophylaxis. Fisher’s exact test was used, p<0.05 was considered significant. Results: 68 patients were evaluated, 51 with moderate antenatal hydronephrosis (normal parenchyma) and 17 with severe antenatal hydroneprohosis (thin parenchyma). Sixteen patients (23.5%) had urinary infection. Neither gender nor hydronephrosis grade were risk factors for urinary infection. 57% (12/21) of the patients with prophylaxis presented UI, compared to 8.5% (4/47) in those without prophylaxis. Prophylaxis increased risk of IU: OR crude 14.3 (CI 95% 3.7-54.7) and adjusted by gender and hydronephrosis grade OR 25 (CI 95%5-125; p<0.001). Conclusions: Urinary infection incidence was 23.5%. Our study shows a major risk of urinary infection in patients with antibiotic prophylaxis.

Keywords

• infección urinaria, hidronefrosis congénita, profilaxis antibiótica