Antibiotic prophylaxis helps prevent recurrent UTI-related new renal scarring
Antibiotic prophylaxis can reduce the risk of new renal scarring associated with recurrent urinary tract infection (UTI), results of the RIVUR* trial have shown.
The authors included 489 patients (mean age, 20.3 months; 91 percent female). Those with recurrent UTI were more likely to have any new renal scarring (odds ratio [OR], 4.1, 95 percent CI, 2.0–8.5; p<0.01) after adjusting for age, sex, index UTI, duplication, bowel bladder dysfunction and antibiotic prophylaxis.
Fewer patients on antibiotic prophylaxis (n=5/244; 2 percent) than on placebo (n=13/245; 5 percent) experienced recurrent UTI-related new renal scarring.
Children on placebo had a higher risk of recurrent UTI-related new renal scarring (OR, 3.1, 1.0–8.8; p=0.04) compared with those on antibiotic prophylaxis after further adjustments for hydronephrosis, vesicoureteral reflux grade and baseline renal scarring.
No between-group differences were observed in scar severity at final dimercaptosuccinic acid scan (p=0.88) or change from baseline (p=0.53).
“It remains unclear why new renal scarring developed in a proportion of [patients] without recurrent urinary tract infection,” the authors said. “The results should be carefully interpreted due to the inherent limitations.”
This study included children with dimercaptosuccinic acid scan within 6 months of enrolment and at least 1 follow-up dimercaptosuccinic acid scan from the RIVUR trial. Recurrent UTI-related new renal scarring, defined as recurrent UTI and new changes on dimercaptosuccinic acid scan, was the primary outcome. Propensity score was used to adjust for confounders due to a low number of events. The associations between covariates and outcome was assessed using multivariate logistic regression.
*Randomized Intervention for Children with Vesicoureteral Reflux