Antimicrobial Resistance and Urinary Tract Infection Recurrence

Area of Science:

• Pediatric Urology
• Infectious Diseases
• Clinical Trials

Background:

• The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial investigated recurrent urinary tract infections (rUTIs) in children.
• Recurrent UTIs with resistant organisms were more frequent in the trimethoprim-sulfamethoxazole prophylaxis (TSP) group.

Purpose of the Study:

• To identify factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) resistance in rUTIs within the RIVUR trial.
• To analyze the incidence and resistance patterns of UTIs in children with VUR receiving prophylactic antibiotics.

Main Methods:

• Children aged 2 to 71 months with VUR and a first or second UTI were randomized to receive either TSP or a placebo for 2 years.
• Factors associated with TMP-SMX-resistant rUTIs were evaluated using data from the RIVUR trial.

Main Results:

• TMP-SMX-resistant organisms were found in 76% of rUTIs in the TSP arm versus 28% in the placebo arm (P < .001).
• The proportion of TMP-SMX-resistant rUTIs decreased over time, with higher resistance in the initial 6 months compared to the final 6 months in both arms.
• No significant difference in UTI recurrence was observed between children with TMP-SMX-resistant versus TMP-SMX-susceptible index UTIs in the TSP group.

Conclusions:

• While TMP-SMX resistance was more prevalent in children on TSP, this resistance diminished over the study period.
• The initial susceptibility of the index UTI to TMP-SMX did not significantly predict subsequent rUTI in children receiving TSP.