ESPN 50th Annual Meeting

ESPN 2017


 
Utility of performing voiding cystourethrogram (VCUG) with antibiotic - An open labelled randomized control trial.
RAJIV SINHA 1 BIPLAB MAJI 1 SUBHASIS SAHA 2 YINCENT TSE 3

1- INSTITUTE OF CHILD HEALTH
2- AMRI
3- GREAT NORTH CHILDREN HOSPITAL
 
Introduction:

Voiding cystourethrogram (VCUG) remains the gold standard for demonstrating the grade of reflux as well as urethral anatomy. Procedure related urinary tract infection (UTI) remains an important concern. There is controversy regarding utility of antibiotic in preventing post VCUG acquired UTI.

Material and methods:

The objective of the study was to assess whether antibiotic reduces VCUG acquired UTI. An open labelled randomized controlled trial (RCT) was conducted at a tertiary paediatric nephrology centre. 120 children (age 2 month to 5 years) undergoing VCUG were randomized into Group A (Antibiotic), or Group B (no antibiotic) in 3:2 ratio. Group A received oral antibiotic (cephalexin if < 6 month or cotrimoxazole if > 6 month old) a day prior VCUG and continued till a day post VCUG. The primary outcome of interest was incidence of VCUG associated UTI.  Urine was checked on day 3 after VCUG and UTI was defined as significant growth of a single organism in a symptomatic child.

Results:

Median age of the study population was 8 months (IQR 13 months) with 68% male. Indication for undertaking VCUG was history of UTI (1st UTI in infancy = 43, recurrent UTI = 49) and congenital anomaly of kidney and urinary tract (CAKUT) without any UTI (n=28). Post VCUG UTI was significantly higher among Group B in comparison to Group A [17% vs 1.4 % p=0.01, OR = 14.2   (95% C.I. = 1.7 to 117)].  Multivariate binary logistic regression analysis found an abnormal pre-VCUG ultrasound scan  to be significant independent risk factors for post VCUG UTI (p = 0.02; OR 9.51- 95% C.I. 1.43 to 63.4).  Number needed to treat with antibiotic to prevent one post VCUG UTI was 6.5, which reduced to 4 if only the group with abnormal pre-VCUG USS were included.

Conclusions:

Antibiotic significantly reduces post VCUG acquired UTI especially in those with abnormal ultrasound scans.