MP64-04 CHALLENGING THE STATUS QUO: A PROSPECTIVE STUDY OF EARLY DISCONTINUATION OF CONTINUOUS ANTIBIOTIC PROPHYLAXIS IN CHILDREN WITH VESICOURETERAL REFLUX
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Résumé
You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Reflux (MP64)1 Apr 2019MP64-04 CHALLENGING THE STATUS QUO: A PROSPECTIVE STUDY OF EARLY DISCONTINUATION OF CONTINUOUS ANTIBIOTIC PROPHYLAXIS IN CHILDREN WITH VESICOURETERAL REFLUX Melissa McGrath*, Smruthi Ramesh, Alanna Webster, Kornelia Palczewski, and Luis H Braga Melissa McGrath*Melissa McGrath* , Smruthi RameshSmruthi Ramesh , Alanna WebsterAlanna Webster , Kornelia PalczewskiKornelia Palczewski , and Luis H BragaLuis H Braga View All Author Informationhttps://doi.org/10.1097/01.JU.0000556896.02462.e6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Continuous antibiotic prophylaxis (CAP) has been recommended for children with VUR until toilet training to prevent urinary tract infections (UTI). We have had the chance to investigate this concept at our institution by prospectively following 2 cohorts, managed by 2 surgeons with differing practices regarding the age of CAP discontinuation (CAP-DC). Our objective was to compare fUTI rates between these 2 cohorts. We hypothesized that UTI rates would be similar for both cohorts, with the early CAP-DC group having a more favorable antibiotic resistance profile. METHODS: We prospectively followed 2 cohorts of patients with primary VUR (0–18 years) from 2009–18 (n=275): CAP-DC occurred at 12–18 months of age in Cohort-I and at toilet training age (24–36 months) in Cohort-II. Age at and mode of presentation, gender, VUR and hydronephrosis (HN) grades, ureteral dilation, UTI and surgery rates, and follow-up time were collected. Our primary outcome was development of fUTI post-CAP-DC in both groups. We performed subgroup analyses to determine risk factors for UTI post-CAP-DC in both cohorts. Statistical analyses consisted of chi-square for categorical data and t-tests for continuous variables. RESULTS: Of 275 patients, 174-63% (Cohort-I) stopped CAP at a mean age of 16mos (IQR 11) and 101-37% (Cohort-II) at 27mos (IQR 25). Patient characteristics are displayed in Table-1. The median age at presentation were 10.4 (IQR: 7) and 7 (IQR: 16) months for Cohort-I and Cohort-II, respectively. Follow-up was 40+26months for Cohort-I vs. 54+34months for Cohort-II (p<0.01). There were more patients with dilating VUR (3-5) (152/174;87%) in Cohort-I vs. Cohort-II (80/101;79%) (p=0.05). A total of 32 patients developed UTI post-CAP-DC [19/174 (11%) vs. 13/101 (13%); p=0.63] and the mean time to the development of UTI post-CAP-DC was 7+8months for Cohort-I vs. 14+20months for Cohort-II (p=0.19) (Table 2). Both groups had similar rates of VUR correcting surgery (25%vs.24% for Cohort-I and II, respectively). CONCLUSIONS: Stopping CAP in VUR children at a median age of 16mos did not result in more UTIs when compared to the traditional approach. By adopting such strategy, duration of antibiotic exposure may be decreased without adversely increasing UTI rates. Discontinuation of CAP early may be more beneficial for males as 75% of patients who had UTIs post-CAP-DC were females, had more often BBD and dilating VUR. Source of Funding: none Hamilton, Canada; Hamilton, Canada; Hamilton, Canada; Hamilton, ON© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e942-e942 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Melissa McGrath* More articles by this author Smruthi Ramesh More articles by this author Alanna Webster More articles by this author Kornelia Palczewski More articles by this author Luis H Braga More articles by this author Expand All Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».