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Vesicoureteral Reflux and Antibiotic Prophylaxis: Why Cohorts and Methodologies Matter

2016; Lippincott Williams & Wilkins; Volume: 196; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2016.05.037

1527-3792

Saul P. Greenfield, Earl Y. Cheng, William DeFoor, Bradley P. Kropp, H. Gil Rushton, Steve Skoog, Myra A. Carpenter,

Urinary Tract Infections Management

No AccessJournal of UrologyPediatric Urology1 Oct 2016Vesicoureteral Reflux and Antibiotic Prophylaxis: Why Cohorts and Methodologies Matter Saul P. Greenfield, Earl Cheng, William DeFoor, Bradley Kropp, H. Gil Rushton, Steve Skoog, and Myra Carpenter Saul P. GreenfieldSaul P. Greenfield More articles by this author , Earl ChengEarl Cheng More articles by this author , William DeFoorWilliam DeFoor More articles by this author , Bradley KroppBradley Kropp More articles by this author , H. Gil RushtonH. Gil Rushton More articles by this author , Steve SkoogSteve Skoog More articles by this author , and Myra CarpenterMyra Carpenter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.05.037AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Published cohorts of children with vesicoureteral reflux placed on antibiotic prophylaxis differ in baseline characteristics and methodology. These data have been combined in meta-analyses to derive treatment recommendations. We analyzed these cohorts in an attempt to understand the disparate outcomes reported. Materials and Methods: A total of 18 studies were identified from 1987 to 2013. These series retrospectively or prospectively evaluated children with vesicoureteral reflux who were on long-term antibiotic prophylaxis. Presenting demographic data, criteria and methods of evaluation were tabulated. Outcomes were compared, specifically recurrent urinary infections and renal scarring. Results: Significant differences identified in baseline characteristics included gender, circumcision status and reflux grade, and differences in methodology included evaluation of bowel and bladder dysfunction, method of urine collection, definition of urinary infection, measurement of compliance and means of identifying renal scarring. Cohorts with larger numbers of uncircumcised boys had more breakthrough urinary infections. Infection and renal scarring rates were higher in series with higher grades of reflux. Bagged urine specimens were allowed in 6 series, rendering the data suspect. Children with bowel and bladder dysfunction were excluded from 3 cohorts, and bowel and bladder dysfunction was correlated with outcome in only 1 cohort. Compliance was monitored in only 6 studies. Conclusions: Subpopulations and methodologies vary significantly in published series of children with vesicoureteral reflux on antibiotic prophylaxis. It is inappropriate to combine outcomes data from these series in a meta-analysis, which would serve to blur distinctions between these subpopulations. Broad recommendations or guidelines based on meta-analyses should be viewed with caution. References 1 : clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics2011; 128: 595. Google Scholar 2 : Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol2010; 184: 1134. Link, Google Scholar 3 : Antibiotic prophylaxis for prevention of febrile urinary tract infections in children with vesicoureteral reflux: a meta-analysis of randomized, controlled trials comparing dilated to nondilated vesicoureteral reflux. J Urol2015; 193: 1772. 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Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGreenfield S (2017) Evidence-Based versus Personalized Medicine in Pediatric UrologyJournal of Urology, VOL. 197, NO. 4, (980-981), Online publication date: 1-Apr-2017.Gaither T and Copp H (2016) Vesicoureteral Reflux: How to Interpret Different Studies with Different ResultsJournal of Urology, VOL. 196, NO. 4, (981-982), Online publication date: 1-Oct-2016.Cain M (2016) This Month in Pediatric UrologyJournal of Urology, VOL. 196, NO. 4, (975-976), Online publication date: 1-Oct-2016. Volume 196Issue 4October 2016Page: 1238-1243Supplementary Materials Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.Keywordsantibiotic prophylaxisvesico-ureteral refluxcohort studiesMetricsAuthor Information Saul P. Greenfield More articles by this author Earl Cheng More articles by this author William DeFoor More articles by this author Bradley Kropp More articles by this author H. Gil Rushton More articles by this author Steve Skoog More articles by this author Myra Carpenter More articles by this author Expand All Advertisement PDF downloadLoading ...