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S4: VESICOURETERAL REFLUX
Moderators: Andy Kirsch (USA), Pedro-Jose Lopez (Chili)
ESPU Meeting on Thursday 15, October 2015, 08:20 - 09:24
08:20 - 08:25
S4-1
(LO)
★
PATTERNS OF ANTIMICROBIAL RESISTANCE AND URINARY TRACT INFECTION
RECURRENCE AMONG THE RIVUR COHORT
Caleb NELSON
1
, Alejandro HOBERMAN
2
, Nader SHAIKH
2
, Ron KEREN
3
, Ranjiv MATHEWS
4
, Saul GREENFIELD
5
, Tej
MATTOO
6
, Nathan GOTMAN
7
, Anastasia IVANOVA
7
, Marva MOXEY-MIMS
8
, Myra CARPENTER
7
and Russell CHESNEY
9
1) Boston Children's Hospital, Urology, Boston, USA - 2) Children's Hospital of Pittsburgh, Pediatrics, Pittsburgh, USA -
3) Children's Hospital of Philadelphia, Pediatrics, Philadelphia, USA - 4) Johns Hopkins Hospital, Urology, Baltimore, USA
- 5) Women & Children's Hospital of Buffalo, Department of Pediatric Urology, Buffalo, USA - 6) Children's Hospital of
Michigan, Pediatrics, Detroit, USA - 7) University of North Carolina, Collaborative Studies Coordinating Center, Dept of
Biostatistics, Chapel Hill, USA - 8) National Institutes of Health, National Institute of Diabetes and Digestive and Kidney
Diseases, Bethesda, USA - 9) University of Tennessee Health Science Center, Pediatrics, Memphis, USA
PURPOSE
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 antimicrobial prophylaxis (AP) arm. We sought to
describe antimicrobial resistance patterns in the RIVUR trial.
MATERIAL AND METHODS
Children aged 2-71months with 1
st
or 2
nd
UTI (index UTI) and grade I-IV vesicoureteral reflux (VUR) were randomized to
AP with trimethoprim-sulfamethoxazole (TMP-SMX) 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 34/278 children receiving AP versus 67/293 children receiving placebo. Among those with rUTI, 76%
(26/34) of AP subjects had TMP-SMX-resistant organisms vs. 28% (19/67) of placebo subjects (p<0.001). The
proportion of resistant rUTI decreased over time; in the AP arm, 96% were resistant during the initial 6 months, vs.
38% resistant during the final 6 months; corresponding proportions for the placebo arm were 32% and 11%. Among
children receiving AP, 7/55 (13%) with TMP-SMX-resistant index UTI had rUTI, while 27/223 (12%) with TMP-SMX-
susceptible index UTI had rUTI (adjusted HR: 1.38 [95%CI: 0.54-3.56]). Corresponding proportions in the placebo arm
were 17/65 (26%) and 50/228 (22%) (adjusted HR: 1.33 [95% CI: 0.74-2.38]).
CONCLUSIONS
Although TMP-SMX resistance is more common among children treated with AP versus placebo, resistant infection
frequency decreased over time. Resistance of the index UTI to TMP-SMX does not reduce the effectiveness of AP with
TMP-SMX to prevent rUTI.