Regenerative
Longer ureteral stents in children tied to higher infection risk despite antibiotics
By Life and Health Today Staff, . Life and Health Today.
More than one in four children fitted with a double-J ureteral stent, a small flexible tube placed inside the urinary tract to keep urine draining from the kidney to the bladder, developed a symptomatic urinary tract infection while the device was in place, even though every patient was taking daily preventive antibiotics. The finding comes from a retrospective cohort study, meaning researchers looked back through existing records rather than assigning treatments prospectively, published October 22, 2026, in the Journal of Pediatric Urology.
What the study measured
The stents were placed for four different conditions affecting the connection between the kidney and bladder. All patients received a short course of oral cefixime after the procedure, then switched to daily trimethoprim-sulfamethoxazole, a standard antibiotic combination, for as long as the stent remained in place.
Overall, 27.4% of the children developed a symptomatic breakthrough infection during that period. Symptomatic meant clinical signs such as fever, new pain, or, in infants, unexplained irritability, confirmed by a positive urine culture.
How duration changed the odds
The clearest signal in the data was time. Children whose stents stayed in for more than four weeks had an infection rate of 38.1%, compared with 16.4% in those whose stents came out within four weeks. The odds ratio was 3.14, meaning the longer group was roughly three times as likely to develop an infection, a difference the authors reported as statistically significant (P = .006). Children who had experienced a urinary tract infection before the procedure also faced higher odds afterward, with an odds ratio of 2.80 (P = .010).
Because this is a retrospective study, the association between longer dwell time and infection cannot be read as proof of cause and effect. Children who needed stents for longer may have had more complex underlying conditions that independently raised their infection risk.
The bacteria involved
Of the infections that did occur, the microbiological picture was concerning. Escherichia coli accounted for 47.1% of the organisms identified, followed by Klebsiella pneumoniae at 20.6%, Enterococcus species at 14.7%, and Pseudomonas aeruginosa and Proteus mirabilis at 8.8% each. Nearly a third of all isolates, 32.4%, were confirmed multidrug-resistant organisms, meaning standard antibiotics would not reliably treat them. Another 26.5% produced extended-spectrum beta-lactamases, enzymes that break down a broad class of antibiotics and narrow treatment options further.
The authors wrote that, given the prevalence of these resistant organisms, management should focus on minimizing stent dwell time and relying on culture-guided treatment, meaning choosing antibiotics based on what the lab shows is actually present, rather than escalating preventive regimens across the board.
What the study could not answer
The cohort was drawn from a single institution and included children with four different surgical indications, which the authors acknowledged may have introduced clinical variation that the sample size of 124 patients was too small to fully untangle. Urine cultures were only collected when symptoms appeared, so silent colonization of the stent itself was not captured, and stent tips were not cultured after removal. Those gaps mean the true rate of bacterial presence on the devices is unknown.
No funding supported the study, and the lead author disclosed no conflicts of interest.
For families whose children are scheduled for stent placement, the practical question this raises, whether a shorter dwell time is possible in their child's specific case, is one for the treating urologist who knows the clinical details. What the data adds is a clearer picture of how quickly the risk profile changes once a stent passes the four-week mark.
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