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Uropathogen Resistance and Antibiotic Prophylaxis: A Meta-analysis

Rachel E Selekman1, Daniel J Shapiro2, John Boscardin3

  • 1Departments of Urology.

Pediatrics
|June 30, 2018
PubMed

Insights

Antibiotic prophylaxis for children with vesicoureteral reflux significantly increases the risk of multidrug-resistant urinary tract infections (UTIs). This finding impacts the assessment of prophylaxis benefits and treatment strategies for recurrent UTIs.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Limited data exist on uropathogen resistance in randomized controlled trials (RCTs) for urinary tract infection (UTI) prevention.
  • Antibiotic prophylaxis is a common strategy for preventing recurrent UTIs in children with vesicoureteral reflux (VUR).

Purpose of the Study:

  • To assess the impact of antibiotic prophylaxis on the development of multidrug-resistant (MDR) first recurrent UTIs in children with VUR.

Main Methods:

  • Systematic review and meta-analysis of RCTs involving pediatric patients (≤18 years) with VUR receiving continuous antibiotic prophylaxis.
  • Data extraction and quality assessment followed PRISMA guidelines.
  • Mixed-effects logistic regression was used for adjusted meta-analyses.

Main Results:

  • Patients receiving prophylaxis were significantly more likely to develop MDR infections (33% vs. 6%, P < .001).
  • Prophylaxis recipients had 6.4 times the odds of developing MDR infections (95% CI: 2.7-15.6).
  • One MDR infection occurred for every 21 children treated with prophylaxis.

Conclusions:

  • Antibiotic prophylaxis for VUR increases the risk of multidrug resistance in recurrent UTIs.
  • This necessitates a re-evaluation of the risk-benefit profile of prophylaxis.
  • Findings have implications for empirical treatment selection in breakthrough infections.
Abstract

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