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The Swedish Reflux Trial in Children: III. Urinary Tract Infection Pattern

2010; Lippincott Williams & Wilkins; Volume: 184; Issue: 1 Linguagem: Inglês

10.1016/j.juro.2010.01.061

1527-3792

Per Brandström, Elisabeth Esbjörner, Maria Herthelius, Svante Swerkersson, Ulf Jodal, Sverker Hansson,

Gastroesophageal reflux and treatments

No AccessJournal of UrologyPediatric Urology1 Jul 2010The Swedish Reflux Trial in Children: III. Urinary Tract Infection Pattern Per Brandström, Elisabeth Esbjörner, Maria Herthelius, Svante Swerkersson, Ulf Jodal, and Sverker Hansson Per BrandströmPer Brandström Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden , Elisabeth EsbjörnerElisabeth Esbjörner Department of Pediatrics, Örebro University Hospital, Örebro, Sweden , Maria HertheliusMaria Herthelius Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden , Svante SwerkerssonSvante Swerkersson Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden , Ulf JodalUlf Jodal Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden , and Sverker HanssonSverker Hansson Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden View All Author Informationhttps://doi.org/10.1016/j.juro.2010.01.061AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated the difference in the febrile urinary tract infection rate in small children with dilating vesicoureteral reflux randomly allocated to 3 management alternatives, including antibiotic prophylaxis, endoscopic treatment or surveillance only as the control. Materials and Methods: At 23 centers a total of 203 children were included in the study, including 128 girls and 75 boys 1 to younger than 2 years. Vesicoureteral reflux grade III in 126 cases and IV in 77 was detected after a febrile urinary tract infection (194) after prenatal screening (9). Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years. The febrile urinary tract infection rate was analyzed by the intent to treat principle. Results: We noted a total of 67 febrile recurrences in 42 girls and a total of 8 in 7 boys (p = 0.0001). There was a difference in the recurrence rate among treatment groups in girls with febrile infection in 8 of 43 (19%) on prophylaxis, 10 of 43 (23%) with endoscopic therapy and 24 of 42 (57%) on surveillance (p = 0.0002). In girls the recurrence rate was associated with persistent reflux after 2 years (p = 0.0095). 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Google Scholar © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byRouth J (2018) Endoscopic Therapy for High Grade Vesicoureteral Reflux—First Line Therapy or Too Good to be True?Journal of Urology, VOL. 200, NO. 3, (510-511), Online publication date: 1-Sep-2018.Wang Z, Wehbi E, Alam Y and Khoury A (2017) A Reanalysis of the RIVUR Trial Using a Risk Classification SystemJournal of Urology, VOL. 199, NO. 6, (1608-1614), Online publication date: 1-Jun-2018.Arlen A, Leong T, Guidos P, Alexander S and Cooper C (2017) Distal Ureteral Diameter Ratio is Predictive of Breakthrough Febrile Urinary Tract InfectionJournal of Urology, VOL. 198, NO. 6, (1418-1423), Online publication date: 1-Dec-2017.Greenfield S, Cheng E, DeFoor W, Kropp B, Rushton H, Skoog S and Carpenter M (2016) Vesicoureteral Reflux and Antibiotic Prophylaxis: Why Cohorts and Methodologies MatterJournal of Urology, VOL. 196, NO. 4, (1238-1243), Online publication date: 1-Oct-2016.Arlen A, Merriman L, Kirsch J, Leong T, Scherz H, Smith E, Broecker B and Kirsch A (2014) Early Effect of American Academy of Pediatrics Urinary Tract Infection Guidelines on Radiographic Imaging and Diagnosis of Vesicoureteral Reflux in the Emergency Room SettingJournal of Urology, VOL. 193, NO. 5S, (1760-1765), Online publication date: 1-May-2015.Alexander S, Arlen A, Storm D, Kieran K and Cooper C (2014) Bladder Volume at Onset of Vesicoureteral Reflux is an Independent Risk Factor for Breakthrough Febrile Urinary Tract InfectionJournal of Urology, VOL. 193, NO. 4, (1342-1346), Online publication date: 1-Apr-2015.Moriya K, Mitsui T, Kitta T, Nakamura M, Kanno Y, Kon M, Nishimura Y, Shinohara N and Nonomura K (2014) 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 InfectionJournal of Urology, VOL. 193, NO. 2, (637-642), Online publication date: 1-Feb-2015.Juliano T, Stephany H, Clayton D, Thomas J, Pope J, Adams M, Brock J and Tanaka S (2013) Incidence of Abnormal Imaging and Recurrent Pyelonephritis after First Febrile Urinary Tract Infection in Children 2 to 24 Months OldJournal of Urology, VOL. 190, NO. 4S, (1505-1510), Online publication date: 1-Oct-2013.Bush N (2012) Risk of Febrile Urinary Tract Infection After Reflux Surgery—Does the Type of Procedure Matter?Journal of Urology, VOL. 189, NO. 1, (14-15), Online publication date: 1-Jan-2013.Drzewiecki B, Thomas J, Pope J, Adams M, Brock J and Tanaka S (2012) Observation of Patients with Vesicoureteral Reflux Off Antibiotic Prophylaxis: Physician Bias on Patient Selection and Risk Factors for Recurrent Febrile Urinary Tract InfectionJournal of Urology, VOL. 188, NO. 4S, (1480-1484), Online publication date: 1-Oct-2012.Skoog S and Steinhardt G (2012) Prophylaxis Versus No Prophylaxis for RefluxJournal of Urology, VOL. 187, NO. 4, (1161-1163), Online publication date: 1-Apr-2012.Sillén U, Brandström P, Jodal U, Holmdahl G, Sandin A, Sjöberg I and Hansson S (2010) The Swedish Reflux Trial in Children: V. Bladder DysfunctionJournal of Urology, VOL. 184, NO. 1, (298-304), Online publication date: 1-Jul-2010.Brandström P, Nevéus T, Sixt R, Stokland E, Jodal U and Hansson S (2010) The Swedish Reflux Trial in Children: IV. Renal DamageJournal of Urology, VOL. 184, NO. 1, (292-297), Online publication date: 1-Jul-2010.Holmdahl G, Brandström P, Läckgren G, Sillén U, Stokland E, Jodal U and Hansson S (2010) The Swedish Reflux Trial in Children: II. Vesicoureteral Reflux OutcomeJournal of Urology, VOL. 184, NO. 1, (280-285), Online publication date: 1-Jul-2010.Brandström P, Esbjörner E, Herthelius M, Holmdahl G, Läckgren G, Nevéus T, Sillén U, Sixt R, Sjöberg I, Stokland E, Jodal U and Hansson S (2010) The Swedish Reflux Trial in Children: I. Study Design and Study Population CharacteristicsJournal of Urology, VOL. 184, NO. 1, (274-279), Online publication date: 1-Jul-2010. Volume 184Issue 1July 2010Page: 286-291 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Keywordsurinary tract infectionsantibiotic prophylaxisvesico-ureteral refluxcicatrixkidneyAcknowledgmentsTina Linnér assisted with coordination.Metrics Author Information Per Brandström Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden More articles by this author Elisabeth Esbjörner Department of Pediatrics, Örebro University Hospital, Örebro, Sweden More articles by this author Maria Herthelius Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, Sweden More articles by this author Svante Swerkersson Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden More articles by this author Ulf Jodal Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden More articles by this author Sverker Hansson Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden More articles by this author Expand All Advertisement PDF downloadLoading ...