Early Discontinuation of Antibiotic Prophylaxis in Patients with Persistent Primary Vesicoureteral Reflux Initially Detected during Infancy: Outcome Analysis and Risk Factors for Febrile Urinary Tract Infection

No AccessJournal of UrologyPediatric Urology1 Feb 2015Early Discontinuation of Antibiotic Prophylaxis in Patients with Persistent Primary Vesicoureteral Reflux Initially Detected during Infancy: Outcome Analysis and Risk Factors for Febrile Urinary Tract Infection Kimihiko Moriya, Takahiko Mitsui, Takeya Kitta, Michiko Nakamura, Yukiko Kanno, Masafumi Kon, Yoko Nishimura, Nobuo Shinohara, and Katsuya Nonomura Kimihiko MoriyaKimihiko Moriya More articles by this author , Takahiko MitsuiTakahiko Mitsui More articles by this author , Takeya KittaTakeya Kitta More articles by this author , Michiko NakamuraMichiko Nakamura More articles by this author , Yukiko KannoYukiko Kanno More articles by this author , Masafumi KonMasafumi Kon More articles by this author , Yoko NishimuraYoko Nishimura More articles by this author , Nobuo ShinoharaNobuo Shinohara More articles by this author , and Katsuya NonomuraKatsuya Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.08.007AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We retrospectively assessed the incidence of and risk factors for febrile urinary tract infection in children during active surveillance after early discontinuation of antibiotic prophylaxis. Materials and Methods: We retrospectively evaluated 9 females and 61 uncircumcised males diagnosed with primary vesicoureteral reflux before age 1 year who had persistent reflux on followup voiding cystourethrogram and were subsequently followed under active surveillance without continuous antibiotic prophylaxis. Patients with secondary vesicoureteral reflux or associated urological abnormality were excluded. Clinical outcomes, including incidence of febrile urinary tract infection and new scar formation, were evaluated. Risk factors for febrile urinary tract infection were also analyzed. Results: Mean age at stopping continuous antibiotic prophylaxis was 21 months, and mean followup was 61 months. During active surveillance 21 patients had febrile urinary tract infection, and the 5-year infection-free rate under active surveillance was 67.5%. One or 2 foci of minimal new scarring developed in 4 of 16 patients who underwent followup dimercapto-succinic acid scan after febrile urinary tract infection. On multivariate analysis dilated vesicoureteral reflux on followup voiding cystourethrogram was the only significant risk factor for febrile urinary tract infection. Conclusions: This study revealed that about two-thirds of patients with persistent vesicoureteral reflux were free of febrile urinary tract infection during 5 years of active surveillance. Those with dilated vesicoureteral reflux on followup voiding cystourethrogram are at significantly greater risk for febrile urinary tract infection. Accordingly active surveillance, especially in patients with nondilated vesicoureteral reflux on followup voiding cystourethrogram, seems to be a safe option even in children who have not yet been toilet trained. References 1 : Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol2010; 184: 1134. Link, Google Scholar 2 : The outcome of stopping prophylactic antibiotics in older children with vesicoureteral reflux. J Urol2000; 163: 269. Link, Google Scholar 3 : Cessation of prophylactic antibiotics for managing persistent vesicoureteral reflux. J Urol2001; 166: 1465. Link, Google Scholar 4 : Can prophylactic antibiotics safely be discontinued in children with vesicoureteral reflux?. J Urol2005; 174: 1587. Link, Google Scholar 5 : Could prophylactic antibiotics be stopped in patients with history of vesicoureteral reflux?. J Pediatr Urol2009; 5: 383. Google Scholar 6 : Outcome after discontinuing prophylactic antibiotics in children with persistent vesicoureteral reflux. J Urol2010; 184: 1594. Link, Google Scholar 7 : Outcome of antibiotic prophylaxis discontinuation in patients with persistent vesicoureteral reflux initially presenting with febrile urinary tract infection: time to event analysis. J Urol2010; 184: 1093. Link, Google Scholar 8 : Observation of patients with vesicoureteral reflux off antibiotic prophylaxis: physician bias on patient selection and risk factors for recurrent febrile urinary tract infection. J Urol2012; 188: 1480. Link, Google Scholar 9 Medical versus surgical treatment of primary vesicoureteral reflux: a prospective international reflux study in children. J Urol1981; 125: 277. Google Scholar 10 : Renal scars and parenchymal thinning in children with vesicoureteral reflux: a 5-year report of the International Reflux Study in Children (European branch). J Urol1992; 148: 1653. Link, Google Scholar 11 : Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol1997; 157: 1846. Link, Google Scholar 12 : Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics2006; 117: 626. Google Scholar 13 : Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics2008; 122: 1064. Google Scholar 14 : Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics2008; 121: e1489. Google Scholar 15 : Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol2008; 179: 674. Link, Google Scholar 16 : The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol2010; 184: 286. Link, Google Scholar 17 : Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med2014; 370: 2367. Google Scholar 18 : Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis2007; 45: 273. Google Scholar 19 : Antibiotic resistance patterns of community-acquired urinary tract infections in children with vesicoureteral reflux receiving prophylactic antibiotic therapy. Pediatrics2008; 122: 1212. Google Scholar 20 : Vesicoureteral reflux and evidence-based management. J Pediatr2001; 139: 620. Google Scholar 21 : Predictive factors of early spontaneous resolution in children with primary vesicoureteral reflux. J Urol2007; 178: 1684. Link, Google Scholar 22 : Clinical characteristics of primary vesicoureteral reflux in infants: multicenter retrospective study in Japan. J Urol2003; 169: 309. Link, Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByGarcia-Roig M, Travers C, McCracken C and Kirsch A (2018) National Trends in the Management of Primary Vesicoureteral Reflux in ChildrenJournal of Urology, VOL. 199, NO. 1, (287-293), Online publication date: 1-Jan-2018.Garcia-Roig M, Ridley D, McCracken C, Arlen A, Cooper C and Kirsch A (2018) Vesicoureteral Reflux Index: Predicting Primary Vesicoureteral Reflux Resolution in Children Diagnosed after Age 24 MonthsJournal of Urology, VOL. 197, NO. 4, (1150-1157), Online publication date: 1-Apr-2017.Ritchey M (2018) This Month in Pediatric UrologyJournal of Urology, VOL. 193, NO. 2, (385-386), Online publication date: 1-Feb-2015. Volume 193Issue 2February 2015Page: 637-642 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsvesico-ureteral refluxurinary tract infectionswatchful waitingrisk factorsMetricsAuthor Information Kimihiko Moriya More articles by this author Takahiko Mitsui More articles by this author Takeya Kitta More articles by this author Michiko Nakamura More articles by this author Yukiko Kanno More articles by this author Masafumi Kon More articles by this author Yoko Nishimura More articles by this author Nobuo Shinohara More articles by this author Katsuya Nonomura More articles by this author Expand All Advertisement PDF DownloadLoading ...