Fellow: Amanda Messer, Texas Children's Hospital, Baylor College of Medicine
Article: Hewitt IK, Pennesi M, Morello W, et al. Antibiotic Prophylaxis for Urinary Tract Infection - Related Renal Scarring: A Systematic Review. Pediatrics. 2017; 139(5): e20163145.
Summary: The authors conducted a systematic review of the current literature surrounding UTI prophylaxis and performed a meta-analysis to evaluate the effect of antibiotic prophylaxis on UTI-related renal scarring. Most previous studies focused on reduction in number of UTIs and were not powered to evaluate renal scarring specifically. The studies included in the meta-analysis were prospective, randomized control trials, which detected renal scarring by technetium DMSA scan at entry to study and at 12 months – 2 years. After pooling results from 7 studies (published in 2006 – 2015), the authors found no difference in renal scarring between the prophylaxis and control groups, including patients with vesicoureteral reflux (RR for ALL patients = 0.83, 95% CI 0.55-1.26; RR for VUR patients = 0.82, 95% CI 0.51-1.31). Overall, new renal scarring was found in 5.7% of all children and 6.3% with VUR.
What are the key strengths of the article?
Through pooling data from 7 RCTs, this meta-analysis is powered to investigate the risk of renal scarring, which no single RCT to date has been powered to do.
Are there any limitations or flaws in the article?
Limitations of this article include a lack of blinding in most studies included, variability in the populations studied for each RCT (age, sex, VUR grade), and renal scarring was a secondary outcome in all studies included. Additionally, the follow up technetium DMSA scan at 12 months-2 years may have missed patients who developed renal-scarring after several years.
What is the major takeaway message?
Antibiotic prophylaxis for UTIs in otherwise healthy children does not decrease the risk of subsequent renal scarring, both in the general population and in those with VUR. Children with congenital abnormalities of the kidney and urinary tract are at higher risk for chronic kidney damage and were not included in this study.
Describe how this article should impact our practice.
This meta-analysis supports the current “watchful-waiting” approach recommended in the 2011 AAP UTI Guidelines. As Pediatric Hospitalists, we often care for patients hospitalized for UTIs and are involved in initial decisions regarding antibiotic prophylaxis for these patients. With this study, we have more evidence to support our conversations with families and subspecialists regarding these long-term decisions.
Article: Hewitt IK, Pennesi M, Morello W, et al. Antibiotic Prophylaxis for Urinary Tract Infection - Related Renal Scarring: A Systematic Review. Pediatrics. 2017; 139(5): e20163145.
Summary: The authors conducted a systematic review of the current literature surrounding UTI prophylaxis and performed a meta-analysis to evaluate the effect of antibiotic prophylaxis on UTI-related renal scarring. Most previous studies focused on reduction in number of UTIs and were not powered to evaluate renal scarring specifically. The studies included in the meta-analysis were prospective, randomized control trials, which detected renal scarring by technetium DMSA scan at entry to study and at 12 months – 2 years. After pooling results from 7 studies (published in 2006 – 2015), the authors found no difference in renal scarring between the prophylaxis and control groups, including patients with vesicoureteral reflux (RR for ALL patients = 0.83, 95% CI 0.55-1.26; RR for VUR patients = 0.82, 95% CI 0.51-1.31). Overall, new renal scarring was found in 5.7% of all children and 6.3% with VUR.
What are the key strengths of the article?
Through pooling data from 7 RCTs, this meta-analysis is powered to investigate the risk of renal scarring, which no single RCT to date has been powered to do.
Are there any limitations or flaws in the article?
Limitations of this article include a lack of blinding in most studies included, variability in the populations studied for each RCT (age, sex, VUR grade), and renal scarring was a secondary outcome in all studies included. Additionally, the follow up technetium DMSA scan at 12 months-2 years may have missed patients who developed renal-scarring after several years.
What is the major takeaway message?
Antibiotic prophylaxis for UTIs in otherwise healthy children does not decrease the risk of subsequent renal scarring, both in the general population and in those with VUR. Children with congenital abnormalities of the kidney and urinary tract are at higher risk for chronic kidney damage and were not included in this study.
Describe how this article should impact our practice.
This meta-analysis supports the current “watchful-waiting” approach recommended in the 2011 AAP UTI Guidelines. As Pediatric Hospitalists, we often care for patients hospitalized for UTIs and are involved in initial decisions regarding antibiotic prophylaxis for these patients. With this study, we have more evidence to support our conversations with families and subspecialists regarding these long-term decisions.