MP64-04 CHALLENGING THE STATUS QUO: A PROSPECTIVE STUDY OF EARLY DISCONTINUATION OF CONTINUOUS ANTIBIOTIC PROPHYLAXIS IN CHILDREN WITH VESICOURETERAL REFLUX
Bibliographic record
Abstract
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 ...
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".