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Meta-Analysis
. 2018 Jul;142(1):e20180119.
doi: 10.1542/peds.2018-0119.

Uropathogen Resistance and Antibiotic Prophylaxis: A Meta-analysis

Rachel E Selekman  1 , Daniel J Shapiro  2 , John Boscardin  3 , Gabrielle Williams  4 , Jonathan C Craig  4 , Per Brandström  5 , Marco Pennesi  6 , Gwenalle Roussey-Kesler  7 , Pankaj Hari  8 , Hillary L Copp  9
Affiliations
Meta-Analysis

Uropathogen Resistance and Antibiotic Prophylaxis: A Meta-analysis

Rachel E Selekman et al. Pediatrics. 2018 Jul.

Abstract

Context: Limited data exist regarding uropathogen resistance in randomized controlled trials of urinary tract infection (UTI) prevention and antibiotic prophylaxis.

Objective: To assess the effect of prophylaxis on developing a multidrug-resistant first recurrent UTI among children with vesicoureteral reflux.

Data sources: Cochrane Kidney and Transplant Specialized Register through May 25, 2017.

Study selection: 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.

Data extraction: 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.

Results: 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%, P < .001) and were more likely to receive broad-spectrum antibiotics (68% vs 49%, P = .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.

Limitations: Variables that may contribute to resistance such as medication adherence and antibiotic exposure for other illnesses could not be evaluated.

Conclusions: 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.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart summarizing literature search results.
FIGURE 2
FIGURE 2
Forest plot for odds of multidrug-resistant first recurrent UTIs with antibiotic prophylaxis use among children with recurrent UTIs and VUR stratified by risk of bias. Squares with horizontal lines indicate the odds ratios with 95% CIs for a given study. Lateral tips of diamonds represent summary measures and associated 95% CIs. D + L, DerSimonian and Laird; ID, identification; OR, odds ratio.
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