Year: 2016
Type: article
Abstract: BACKGROUND: The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial found that recurrent urinary tract infections (rUTI) with resistant organisms were more common in the trimethoprim-sulfamethoxazole prophylaxis (TSP) arm. We describe factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) resistance of rUTIs in RIVUR. METHODS: Children aged 2 to 71 months with first or second UTI (index UTI) and grade I to IV vesicoureteral reflux (VUR) were randomized to TSP or placebo and followed for 2 years. Factors associated with TMP-SMX-resistant rUTI were evaluated. RESULTS: Among 571 included children, 48% were <12 months old, 43% had grade II VUR, and 38% had grade III VUR. Recurrent UTI occurred in 34 of 278 children receiving TSP versus 67 of 293 children receiving placebo. Among those with rUTI, 76% (26/34) of subjects receiving TSP had TMP-SMX-resistant organisms versus 28% (19/67) of subjects receiving placebo (P < .001). The proportion of TMP-SMX-resistant rUTI decreased over time: in the TSP arm, 96% were resistant during the initial 6 months versus 38% resistant during the final 6 months; corresponding proportions for the placebo arm were 32% and 11%. Among children receiving TSP, 7 (13%) of 55 with TMP-SMX-resistant index UTI had rUTI, whereas 27 (12%) of 223 with TMP-SMX-susceptible index UTI had rUTI (adjusted hazard ratio 1.38, 95% confidence interval 0.54-3.56). Corresponding proportions in placebo arm were 17 (26%) of 65 and 50 (22%) of 228 (adjusted hazard ratio 1.33, 95% confidence interval 0.74-2.38). CONCLUSIONS: Although TMP-SMX resistance is more common among children treated with TSP versus placebo, resistance decreased over time. Among children treated with TSP, there was no significant difference in UTI recurrence between those with TMP-SMX-resistant index UTI versus TMP-SMX-susceptible UTI.
Source: PEDIATRICS
Institutions: Boston Children's Hospital, Children's Hospital of Pittsburgh, Children's Hospital of Philadelphia, Johns Hopkins University, Johns Hopkins Medicine, Women & Children's Hospital of Buffalo, Children's Hospital of Michigan, University of North Carolina at Chapel Hill, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, University of Tennessee Health Science Center
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: U.S. Department of Health and Human Services, Children's Hospital of Philadelphia, University of Pittsburgh, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: G1037376802, Limited Competition for Continuation of RIVUR, Randomized Intervention for Vesico-Ureteral Reflux (RIVUR) Trial, G2871456257, University of Pittsburgh Clinical and Translational Science Institute, G517149770, RIVUR Study, Randomized Intervention for VesicolUreteral Reflux (RIVUR) Study, University of Pittsburgh Clinical and Translational Science Institute, G626896301, RIVUR - Randomized Intervention for Children with Vesicoureteral Reflux, Institutional Clinical and Translational Science Award, Clinical Outcomes for Siblings of Children with Vesico-Ureteral Reflux, Randomized Intervention for Vesicoureteral Reflux (RIVUR), G9000079931
OpenAlex ID: W2293902824