Risk factors for breakthrough urinary tract infection in children with vesicoureteral reflux receiving continuous antibiotic prophylaxis

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Urology

Background:

• Vesicoureteral reflux (VUR) is a common condition in children, increasing the risk of urinary tract infections (UTIs).
• Continuous antibiotic prophylaxis (CAP) is often used to prevent recurrent UTIs in children with VUR.
• Breakthrough urinary tract infections (BT-UTIs) can occur despite CAP, necessitating investigation into associated risk factors.

Purpose of the Study:

• To identify risk factors for breakthrough urinary tract infections (BT-UTIs) in pediatric patients with VUR undergoing continuous antibiotic prophylaxis (CAP).

Main Methods:

• A single-center cohort study analyzed data from 256 children with VUR (Grade I-V) receiving CAP between January 2016 and December 2019.
• Exposure variables included age at initial UTI diagnosis (≤12 months), VUR laterality, renal scarring, renal function, ultrasound findings, and bladder and bowel dysfunction (BBD).
• The primary outcome was the occurrence of BT-UTI.

Main Results:

• A total of 81 out of 256 children (31.64%) experienced BT-UTIs while on CAP.
• Univariate analysis identified younger age at initial UTI diagnosis (≤12 months), bilateral VUR, renal scarring, and BBD as significant correlates of BT-UTI.
• Multivariate analysis confirmed younger age at initial UTI diagnosis (HR: 4.629), bilateral VUR (HR: 2.078), and BBD (HR: 3.194) as independent risk factors for BT-UTI.

Conclusions:

• Younger age at initial UTI diagnosis (≤12 months), bilateral VUR, and bladder and bowel dysfunction (BBD) are significant independent risk factors for breakthrough UTIs in children with VUR receiving CAP.
• These findings highlight specific patient subgroups at higher risk for treatment failure.
• Understanding these risk factors can aid in optimizing management strategies for VUR in children.