MP25-18 OPTIMAL MANAGEMENT OF CONTINUOUS ANTIBIOTIC PROPHYLAXIS AFTER INITIAL BREAKTHROUGH UTI IN CHILDREN WITH VESICOURETERAL REFLUX

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I (MP25)1 Sep 2021MP25-18 OPTIMAL MANAGEMENT OF CONTINUOUS ANTIBIOTIC PROPHYLAXIS AFTER INITIAL BREAKTHROUGH UTI IN CHILDREN WITH VESICOURETERAL REFLUX Lane Shish, and Kathleen Kieran Lane ShishLane Shish More articles by this author , and Kathleen KieranKathleen Kieran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002022.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Continuous antibiotic prophylaxis (CAP) can reduce the risk of recurrent urinary tract infections (UTI) for children with vesicoureteral reflux (VUR). If a child has a breakthrough UTI (BT-UTI) while on CAP, current guidelines suggest surgical repair or continuing CAP after changing the agent. However, the latter option is based primarily on expert opinion. This study evaluated if switching the CAP agent after children had an initial BT-UTI changed the risk of a second-UTI compared to leaving CAP unchanged. We hypothesized that there was no difference in UTI recurrence in the cohort of patients in whom CAP agent was changed compared with those continued on the same CAP agent after BT-UTI. METHODS: We retrospectively identified all children aged 0-18 months with radiographically confirmed primary VUR and a BT-UTI while on CAP for UTI prevention between January 2013 and August 2020. Patient demographics, BT-UTI characteristics, time on CAP agents, and incidence and timing of second BT-UTI (when applicable) were collected. The primary outcome was the relative risk of a second BT-UTI in patients with CAP agent changed after the initial BT-UTI versus unchanged. The secondary outcome was the rate ratio of second BT-UTIs per person-years on CAP after the initial BT-UTI when the CAP agent was changed versus unchanged. RESULTS: Sixty-two patients were identified: 24 (38.7%) had CAP changed and 38 had CAP unchanged. A second BT-UTI developed in 12/24 children (50%) with CAP changed and in 22/38 children (57.9%) with CAP unchanged. The relative risk of a second BT-UTI when CAP was changed (versus unchanged) was 0.86 (p=0.55). The rate of second BT-UTIs when the CAP was changed was 12 cases per 18.34 person-years after the initial BT-UTI and 22 cases per 22.36 person-years after the initial BT-UTI when CAP was unchanged. The rate ratio of second BT-UTI in changed CAP cohort was 0.67 (p=0.25). Of the children in the changed CAP cohort with a second BT-UTI, 33.3% had developed resistance to both their initial and contemporary CAP agent. CONCLUSIONS: Changing a child’s UTI CAP after an initial BT-UTI did not significantly change the risk of a second BT-UTI compared to leaving CAP unchanged, while it did introduce a risk of developing a second UTI with increased antibiotic resistance. This suggests that, after an initial BT-UTI, changing CAP may not confer clinical benefit and may increase the prevalence of resistant micro-organisms. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e460-e461 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lane Shish More articles by this author Kathleen Kieran More articles by this author Expand All Advertisement Loading ...