J Korean Med Sci.  2019 Jun;34(21):e156. 10.3346/jkms.2019.34.e156.

Susceptibility of the Index Urinary Tract Infection to Prophylactic Antibiotics Is a Predictive Factor of Breakthrough Urinary Tract Infection in Children with Primary Vesicoureteral Reflux Receiving Continuous Antibiotic Prophylaxis

Affiliations
  • 1Department of Urology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. skchung@knu.ac.kr
  • 2Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
  • 3Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
  • 4Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
  • 5Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Abstract

BACKGROUND
Few studies have reported on breakthrough urinary tract infection (UTI) associated with the susceptibility of index UTI to prophylactic antibiotics in children with primary vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). We assessed the impact of the susceptibility of index UTI to prophylactic antibiotics in breakthrough UTIs in children with primary VUR receiving CAP.
METHODS
We retrospectively reviewed the medical records of 81 children with primary VUR who were diagnosed after febrile or symptomatic UTI and subsequently received trimethoprim-sulfamethoxazole (TMP-SMX) as CAP between January 2010 and December 2013. We allocated children to a susceptible group or a resistant group based on the susceptibility of index UTI to TMP-SMX. We evaluated patient demographics and clinical outcomes after CAP according to the susceptibility of index UTI to TMP-SMX. Multivariate analysis was used to identify the predictive factors for breakthrough UTI.
RESULTS
Of the 81 children, 42 were classified into the susceptible group and 39 into the resistant group. The proportion of breakthrough UTI was 31.0% (13/42) in the susceptible group and 53.8% (21/39) in the resistant group (P = 0.037). Progression of renal scarring was observed in 0% of children in the susceptible group and 15% in the resistant group (P = 0.053). Multivariate analysis showed that TMP-SMX resistance and initial renal scarring were significant predictors of breakthrough UTI.
CONCLUSION
Susceptibility of index UTI to prophylactic antibiotics is a risk factor of breakthrough UTI and is associated with poor clinical outcomes in children with primary VUR receiving CAP.

Keyword

Vesicoureteral Reflux; Urinary Tract Infections; Antibiotic Prophylaxis
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2021 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr