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Abstract: FR-PO1167

Antibiotic Prophylaxis for Prevention of Urinary Tract Infections in the First Year of Life in Children with Vesicoureteral Reflux Diagnosed Following Antenatal Hydronephrosis: A Systematic Review

Session Information

  • Pediatric Nephrology - I
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Leigh, Jennifer, McMaster University, Hamilton, Ontario, Canada
  • Sanger, Stephanie, McMaster University, Hamilton, Ontario, Canada
  • Petropoulos, Jo-Anne, McMaster University, Hamilton, Ontario, Canada
  • Braga, Luis H., Hamilton Health Science, Hamilton, Ontario, Canada
  • Chanchlani, Rahul, McMaster University, Hamilton, Ontario, Canada
Background

Children with antenatal hydronephrosis (ANH) and vesicoureteral reflux (VUR) are presumed to be at higher risk of urinary tract infection (UTI) after birth. As such, continuous antibiotic prophylaxis (CAP) has been empirically recommended for newborns who have ANH and VUR to reduce the rate of UTI during the first year of life, however, there is limited data to support this practice. The objective of this systematic review was to determine whether CAP prevents UTI within the 1st year of life in children with VUR diagnosed in the workup of ANH.

Methods

A systematic search of all relevant studies was conducted using 4 electronic (Medline, Embase, CINAHL, and CENTRAL) databases using appropriate key words without language restriction by an expert librarian. A time limit of January 1985 to May 2017 was applied. Eligible studies included children with VUR diagnosed in the workup of ANH with or without antibiotic prophylaxis, and reported development of UTI. Two independent reviewers performed title and abstract screening and full-text review. Primary outcome was to compare rate of UTI among those on CAP to those not on CAP.

Results

Of 6903 citations screened, 17 were selected, giving a total population of 845 (69.1 % male, median age 6 days (IQR= 29) who met the inclusion criteria. Most studies were retrospective, and of low quality evidence. Overall, 14.7% of patients developed at least one breakthrough UTI despite being on CAP. A common theme throughout studies was that higher grade VUR (IV-V) was associated with higher incidence of breakthrough UTI. Only two studies included in our review compared UTI rates in children on CAP (combined UTI risk 13.2%) compared to those not on CAP (UTI risk 42.7%), and thus meta-analysis could not be performed.

Conclusion

Despite the use of CAP, 14.7% of children with VUR diagnosed in the setting of ANH continue to develop UTI. However, there is limited published literature comparing UTI rates in this patient population to those not on CAP, thereby making any meaningful inference impossible. The effect of CAP on UTI rates in patients with ANH and postnatal VUR thus remains unclear and requires further investigation.