Meta-analysis finds 30.5% breakthrough UTI rate in children with VUR on antibiotic prophylaxis
This systematic review and meta-analysis pooled data from 24 observational cohort studies involving 3,264 children with vesicoureteral reflux (VUR) who were receiving continuous antibiotic prophylaxis (CAP). The comparator group was not reported. The primary outcome was breakthrough urinary tract infection (BT-UTI). The pooled incidence of BT-UTI was 30.5%. The analysis identified several factors associated with a higher risk of BT-UTI. These included age less than 1 year (OR 2.04), bilateral reflux (OR 1.81), high-grade reflux (grades IV-V, OR 2.65), symptomatic UTI presentation (OR 2.74), a history of recurrent UTI (OR 2.17), bladder and bowel dysfunction (OR 1.81), increased ureteral diameter ratio (mean difference 0.139), and DMSA renal scar formation (OR 4.40). An external validation of a predictive model derived from these factors at a single center (Children's Hospital of Chongqing Medical University, 2021-2024) reported an area under the curve (AUC) of 0.88 (95% CI 0.82-0.93). Safety and tolerability data for CAP were not reported. Key limitations include the observational nature of all included studies, which precludes causal inference, and the lack of a reported comparator group for the main incidence finding. The follow-up duration was also not reported. The external validation was performed at a single center, limiting generalizability. For practice, this analysis quantifies the substantial risk of breakthrough infection despite prophylaxis in this population and identifies a set of clinical and imaging factors associated with that risk. The derived predictive model requires further prospective validation before clinical use.
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