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      Uropathogen Resistance and Antibiotic Prophylaxis: A Meta-analysis

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          Abstract

          <p class="first" id="d9170247e245">The benefit of prophylaxis must be weighed against its risks. In this meta-analysis, we quantify the risk of developing a multidrug-resistant recurrent UTI. </p><div class="section"> <a class="named-anchor" id="s01"> <!-- named anchor --> </a> <h5 class="section-title" id="d9170247e249">CONTEXT:</h5> <p id="d9170247e251">Limited data exist regarding uropathogen resistance in randomized controlled trials of urinary tract infection (UTI) prevention and antibiotic prophylaxis. </p> </div><div class="section"> <a class="named-anchor" id="s02"> <!-- named anchor --> </a> <h5 class="section-title" id="d9170247e254">OBJECTIVE:</h5> <p id="d9170247e256">To assess the effect of prophylaxis on developing a multidrug-resistant first recurrent UTI among children with vesicoureteral reflux. </p> </div><div class="section"> <a class="named-anchor" id="s03"> <!-- named anchor --> </a> <h5 class="section-title" id="d9170247e259">DATA SOURCES:</h5> <p id="d9170247e261">Cochrane Kidney and Transplant Specialized Register through May 25, 2017.</p> </div><div class="section"> <a class="named-anchor" id="s04"> <!-- named anchor --> </a> <h5 class="section-title" id="d9170247e264">STUDY SELECTION:</h5> <p id="d9170247e266">Randomized controlled trials of patients ≤18 years of age with a history of vesicoureteral reflux being treated with continuous antibiotic prophylaxis compared with no treatment or placebo with available antibiotic sensitivity profiles. </p> </div><div class="section"> <a class="named-anchor" id="s05"> <!-- named anchor --> </a> <h5 class="section-title" id="d9170247e269">DATA EXTRACTION:</h5> <p id="d9170247e271">Two independent observers abstracted data and assessed quality and validity per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Adjusted meta-analyses were performed by using a mixed-effects logistic regression model. </p> </div><div class="section"> <a class="named-anchor" id="s06"> <!-- named anchor --> </a> <h5 class="section-title" id="d9170247e274">RESULTS:</h5> <p id="d9170247e276">One thousand two hundred and ninety-nine patients contributed 224 UTIs. Patients treated with prophylaxis were more likely to have a multidrug-resistant infection (33% vs 6%, <i>P</i> &lt; .001) and were more likely to receive broad-spectrum antibiotics (68% vs 49%, <i>P</i> = .004). Those receiving prophylaxis had 6.4 times the odds (95% confidence interval: 2.7–15.6) of developing a multidrug-resistant infection. One multidrug-resistant infection would develop for every 21 reflux patients treated with prophylaxis. </p> </div><div class="section"> <a class="named-anchor" id="s07"> <!-- named anchor --> </a> <h5 class="section-title" id="d9170247e285">LIMITATIONS:</h5> <p id="d9170247e287">Variables that may contribute to resistance such as medication adherence and antibiotic exposure for other illnesses could not be evaluated. </p> </div><div class="section"> <a class="named-anchor" id="s08"> <!-- named anchor --> </a> <h5 class="section-title" id="d9170247e290">CONCLUSIONS:</h5> <p id="d9170247e292">Prophylaxis increases the risk of multidrug resistance among recurrent infections. This has important implications in the risk-benefit assessment of prophylaxis as a management strategy and in the selection of empirical treatment of breakthrough infections in prophylaxis patients. </p> </div>

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          Author and article information

          Journal
          Pediatrics
          Pediatrics
          American Academy of Pediatrics (AAP)
          0031-4005
          1098-4275
          July 02 2018
          July 2018
          June 28 2018
          July 2018
          : 142
          : 1
          : e20180119
          Article
          10.1542/peds.2018-0119
          6317567
          29954832
          fb8430c3-0152-4f3c-9a67-6ff2b111c723
          © 2018
          History

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