Antibiotic helps prevent voiding cystourethrogram-acquired UTI in children
Treatment with antibiotic results in significant reduction in voiding cystourethrogram (VCUG)-associated urinary tract infection (UTI), especially in children with abnormal ultrasound scans, a study has found.
In an open-label trial, 120 children who were aged 2 months to 5 years and undergoing VCUG were randomly assigned to the group treated with antibiotic (n=72; median age 10 months; 68 percent male) or to the group that did not receive treatment (n=48; median age 7 months; 71 percent male). The antibiotic group received cephalexin if <6 months or cotrimoxazole if >6 months old a day prior to VCUG and continued for 1 day after the procedure.
The primary endpoint was incidence of VCUG-associated UTI. Urine was evaluated on day 3 after VCUG, and UTI was defined as significant growth of a single organism in a symptomatic child.
In the cohort, the most common indications for VCUG were history of UTI (43 children had first UTI in infancy; 49 had recurrent UTI) and congenital anomaly of kidney and urinary tract without any UTI (n=28).
Compared with the antibiotic group, the no-treatment group had a significantly higher proportion of children who developed post-VCUG UTI (17 vs 1.4 percent; p=0.01; odds ratio [OR], 14.2; 95 percent CI, 1.7 to 117).
On multivariate binary logistic regression analysis, an abnormal pre-VCUG ultrasound scan emerged as a significant independent risk factor for post-VCUG UTI (p=0.02; OR, 9.51; 1.43 to 63.4).
The number needed to treat with antibiotic to prevent one episode of post-VCUG UTI was 6.5, which dropped to 4 if antibiotic was restricted to children with abnormal pre-VCUG ultrasound scan.
One of the most common fluoroscopic investigations performed in paediatric radiology (up to 40 percent of all fluoroscopic-guided procedures in some centres), VCUG remains the gold standard for identifying vesicoureteric reflux and demonstrating urethral anatomy. Among the known complications of the procedure, VCUG-acquired UTI is considered an important concern as the condition has been associated with urosepsis and even death. [Pediatr Radiol 2001;1:238–46]