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A novel clinical score to predict breakthrough urinary tract infection in children with VUR: meta-analytic derivation
Honggang Fang1,2,3,4, Xianhai Yu1,2,3,4, Yihang Yu1,2,3,4
1Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.
Insights
This study developed an eight-item risk score to predict breakthrough urinary tract infections (BT-UTIs) in children with vesicoureteral reflux (VUR) on continuous antibiotic prophylaxis (CAP). The score aids in personalized prevention strategies for BT-UTIs.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Clinical Risk Stratification
Background:
- Breakthrough urinary tract infections (BT-UTIs) in children with vesicoureteral reflux (VUR) on continuous antibiotic prophylaxis (CAP) present a significant clinical challenge.
- Existing risk stratification methods for BT-UTIs are limited, lacking validated predictive tools.
Purpose of the Study:
- To identify robust risk factors associated with BT-UTIs in pediatric VUR patients on CAP.
- To develop and validate an evidence-based predictive score for BT-UTIs in this population.
Main Methods:
- A systematic review and meta-analysis of cohort studies were conducted following PRISMA and Cochrane guidelines.
- Pooled effect estimates were calculated, and a scoring system was derived. External validation was performed on a separate cohort.
- Search databases included PubMed, Web of Science, and Embase.
Main Results:
- Twenty-four cohort studies (n=3,264) revealed a pooled BT-UTI incidence of 30.5%.
- Eight stable predictors were identified and incorporated into the BT-UTI risk score: younger age, bilateral reflux, high-grade reflux, symptomatic UTI, recurrent UTI history, bladder and bowel dysfunction, increased ureteral diameter ratio, and DMSA renal scar formation.
- External validation demonstrated high discrimination (AUC 0.88) and clinical utility, with good accuracy (0.84) and sensitivity (0.93) at a cutoff of 17 points.
Conclusions:
- An eight-item BT-UTI risk score was developed and externally validated for children with VUR on CAP.
- The score exhibits high discrimination and clinical utility for individualized risk stratification.
- This tool can guide prevention planning and implementation for BT-UTIs in pediatric VUR patients.
Background:
Breakthrough urinary tract infection (BT-UTI) among children with vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP) remains a clinical challenge with heterogeneous risk profiles and no validated prediction tools. We aimed to identify robust risk factors and develop an evidence-based predictive score for BT-UTI.
Methods:
We conducted a systematic review and meta-analysis following PRISMA and Cochrane guidance, searching PubMed, Web of Science, and Embase for cohort studies. Pooled effect estimates were calculated using appropriate fixed- or random-effects models; a scoring system was derived by natural logarithm transformation of pooled estimates. External validation used a cohort of 158 children with VUR receiving CAP at Children's Hospital of Chongqing Medical University (2021-2024).
Results:
Twenty-four cohort studies (n = 3,264) were included; pooled BT-UTI incidence was 30.5%. From 26 candidate factors, eight stable predictors were retained and incorporated into the score: age < 1 year (OR 2.04), bilateral reflux (OR 1.81), high-grade reflux IV-V (OR 2.65), symptomatic UTI (OR 2.74), history of recurrent UTI (OR 2.17), bladder and bowel dysfunction (BBD; OR 1.81), increased ureteral diameter ratio (UDR; MD 0.139), and DMSA renal scar formation (OR 4.40). External validation showed AUC 0.88 (95% CI 0.82-0.93); at a cutoff of 17 points accuracy was 0.84, and sensitivity 0.93. Calibration and decision-curve analyses indicated good agreement and a positive net clinical benefit.
Conclusions:
We developed and externally validated an eight-item BT-UTI risk score for children with VUR on CAP that demonstrates high discrimination and clinical utility for individualized risk stratification and prevention planning and implementation guidance available.
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