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11–14 APRIL, 2018, HELSINKI, FINLAND
09:25–09:28
S5-8 (PP)
THE INCIDENCE AND RISK FACTORS OF BREAKTHROUGH
URINARY TRACT INFECTION AND URINARY TRACT
INFECTION AFTER STOPPING CONTINUOUS ANTIBIOTIC
PROPHYLAXIS IN CHILDREN WITH PRIMARY
VESICOURETERAL REFLUX
Michiko NAKAMURA
1
, Kimihiko MORIYA
2
, Yoko NISHIMURA
2
, Masafumi KON
2
,
Yukiko KANNO
2
, Takeya KITTA
2
and Nobuo SHINOHARA
2
1) Hokkiado University Graduate School of Medicine, Department of Renal and Genitourinary Surgery, Sapporo, JAPAN
- 2) Hokkaido University Graduate School of Medicine, Renal and Genitourinary Surgery, Sapporo, JAPAN
INTRODUCTION
Our strategy for management of primary vesicoureteral reflux (VUR) is basically active surveillance.
Continuous antibiotic prophylaxis (CAP) is indicated for all children with VUR. We retrospectively
investigated the incidence and risk factors of urinary tract infection (UTI) during and after CAP in
children with primary VUR.
PATIENTS AND METHODS
Among children with primary VUR, we included children who had first detected VUR before
36 months old in this study. VUR was classified into 5 grades, and high grade reflux was defined as
grade 4 and 5. Statistical analysis was performed by Cox's proportional hazard regression model.
P<0.05 was considered significant.
RESULTS
Of 240 children with primary VUR, 203 children (152 boys and 51 girls) were enrolled in the present
study. Median age at initial evaluation was 5.6 months old, and median follow up was 5.2 years.
Presenting symptom was mainly febrile UTI. CAP was administered in 196 children. Breakthrough
UTI was detected in 51 children (26.0 %). Breakthrough UTI occurred within 20 months begin-
ning CAP. Median age at stopping CAP was 24.1 months old. Of 126 children after stopping CAP,
UTI was detected in 27 (21.4 %). Median age of UTI after stopping CAP was 45.7 months old.
On multivariate analysis, risk factor of breakthrough UTI was high grade VUR on initial evalua-
tion (p=0.0202). On the other hand, risk factors of UTI after stopping CAP were girls (p=0.0408)
and abnormal findings of DMSA scan (p=0.0383). UTI during follow up had occurred within age of
10 years.
CONCLUSIONS
We revealed that high grade VUR was risk factor for breakthrough UTI, and girls and abnormal
findings on DMSA scan were risk factors for UTI after stopping CAP. Longer administration of CAP
or prophylactic surgery before recurrent UTI should be indicated in patients with these risk factors.
09:28–09:37
Discussion