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Girls and renal scarring as risk factors for febrile urinary tract infection after stopping antibiotic prophylaxis in children with vesicoureteral reflux

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Abstract

Purpose

To clarify the incidence of and risk factors for febrile urinary tract infection in children with persistent vesicoureteral reflux (VUR) after the discontinuation of continuous antibiotic prophylaxis (CAP), retrospective chart review was performed.

Patients and methods

Among children with primary VUR at 10 years of age or younger at presentation, those who had persistent VUR despite conservative management with CAP and who were subsequently followed after discontinuation of CAP were included. Kaplan–Meier curve and Cox’s proportional hazard regression model were used for evaluation of the incidence of and risk factors for febrile urinary tract infection (fUTI) after stopping CAP.

Results

Among 144 children (99 boys and 45 girls), fUTI developed in 34. The 5-year fUTI-free rate after discontinuation of CAP was 69.4%. On multivariate analyses, girls (p = 0.008) and abnormalities on nuclear renal scans (p = 0.0019), especially focal defect (p = 0.0471), were significant factors for fUTI. Although the fUTI-free rate was not different between children who had no or 1 risk factor, it was significantly lower in children with 2 risk factors than in those with no or 1 risk factor.

Conclusions

The present study revealed that girls and abnormal renal scan, especially focal defect, are risk factors for fUTI. Active surveillance without CAP for persistent VUR seems to be a safe option for children with no or 1 risk factor. Prophylactic surgery or careful conservative follow-up may be an option for girls with abnormal renal scan results if VUR persists under CAP.

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Funding

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Authors and Affiliations

  1. Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Michiko Nakamura, Kimihiko Moriya, Masafumi Kon, Yoko Nishimura, Hiroki Chiba, Takeya Kitta & Nobuo Shinohara

  2. Department of Urology, Sapporo City General Hospital, North-11, West-13, Chuo-Ku, Sapporo, 060-8604, Japan

    Kimihiko Moriya

Authors
  1. Michiko Nakamura
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  2. Kimihiko Moriya
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  3. Masafumi Kon
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  4. Yoko Nishimura
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  5. Hiroki Chiba
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  6. Takeya Kitta
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  7. Nobuo Shinohara
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Contributions

MN contributed to conception and design, data analysis, and manuscript writing/editing. KM was involved in conception and design, data collection, data analysis, and critical revision of the manuscript for scientific and factual content. MK and YN collected and analyzed the data. HC and TK critically revised the manuscript for scientific and factual content. NS supervised the study.

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Correspondence to Kimihiko Moriya.

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The author(s) declare that they have no competing interests.

Ethical approval

This study has been approved by the institutional review board. The institutional review board approved protocol number is 017-0197. The need for written informed consent was waived because this study was conducted by retrospective chart review.

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Nakamura, M., Moriya, K., Kon, M. et al. Girls and renal scarring as risk factors for febrile urinary tract infection after stopping antibiotic prophylaxis in children with vesicoureteral reflux. World J Urol 39, 2587–2595 (2021). https://doi.org/10.1007/s00345-020-03524-1

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  • DOI: https://doi.org/10.1007/s00345-020-03524-1

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