Prevention of UTI in Children with CAKUT: A Medical Challenge

Background: Urinary tract infection (UTI) is commoner in children with Congenital anomalies of the kidney and urinary tract (CAKUT) than in the general paediatric population. Recurrent UTI as a result of CAKUT may predispose children to renal scarring, hypertension and CKD. Prevention of UTI in this group of patients is advocated, but achieving this has become a medical challenge in view of the controversy surrounding use of prophylactic antibiotic.

Methods: This was a 10 year retrospective review of Children with CAKUT who were placed on prophylactic antibiotics over a certain period, at an Academic Hospital in Johannesburg. The rate of UTI, the types of causative organisms isolated and the efficacy of prophylactic antibiotics in preventing UTI were documented.

Results: One hundred and thirty four (134) patients with CAKUT were analyzed. Thirty six (36) of them had been started on prophylactic antibiotics after the diagnosis of CAKUT was made. There was a statistically significant association between the use of prophylactic antibiotics and the rate of UTI (p < 0.001). Patients who were not on a prophylactic antibiotic were five times more likely to have a UTI than those who were on a prophylactic antibiotic (OR = 5.21, P = 0.001, 95% CI: 1.9906 – 13.6277). Patients who were on prophylactic antibiotics showed an altered pattern of isolated bacteria, with Klebsiella pneumoniae being the most common organism isolated, rather than E. coli, when compared to the group that were not on prophylactic antibiotics. There was a statistically significant association between the type of bacteria isolated and the use of antibiotic prophylaxis (p= 0.031).

Conclusion: Antibiotic prophylaxis was very effective in decreasing the rate of UTI in our cohort of patients with CAKUT.