Background: While the use of continuous antibiotic prophylaxis (CAP) has been shown to prevent febrile urinary tract infections (fUTI) in children with vesicoureteral reflux (VUR), not enough is known about its effect on UTI associated morbidity. This study aims to compare the rate of hospitalization between children with VUR who are managed with CAP versus observation.
Methods: This is a secondary analysis of data collected as part of a multicenter retrospective cohort study of children with congenital anomalies of the kidney and urinary tract (CAKUT) aged 0-18 at six children's hospitals between 2018 and 2019. We reviewed the subset of patients with primary VUR. The main exposure was CAP versus observation. Our primary outcome was the proportion of children hospitalized for fUTIs. The secondary outcome was the proportion of antibiotic resistant uropathogens. We adjusted the risk difference for prophylaxis use based on clinically important factors with inverse propensity score weighting.
Results: 101 children were included in the analysis, of which 38.6% (N=39) were on CAP. Children in the CAP group were more likely to have bilateral VUR (66.7% vs 51.6%, p=0.14); otherwise, the two groups were clinically and demographically similar (Table 1). CAP was associated with a 38% relative risk reduction in hospitalization rate for fUTI (53.1% vs 33.1%, p=0.03, 95% CI [-0.38,-0.02]) (Figure 1). There was a trend towards increased antibiotic resistance in the prophylaxis group (p=0.08); however, no significant relationship was found between rate of bacterial resistance and hospital admission.
Conclusion: This study suggests that the use of CAP offers a significant risk reduction in hospitalization for fUTIs in children with VUR. There was a trend towards increased antibiotic resistant uropathogens in the group treated with CAP. Further studies are needed to assess the impact of CAP on rates of hospitalization for UTI associated morbidity in children with VUR.
