MP64-04 CHALLENGING THE STATUS QUO: A PROSPECTIVE STUDY OF EARLY DISCONTINUATION OF CONTINUOUS ANTIBIOTIC PROPHYLAXIS IN CHILDREN WITH VESICOURETERAL REFLUX
Bibliographic record
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 (0e18 years) from 2009e18 (n[275): CAP-DC occurred at 12e18 months of age in Cohort-I and at toilet training age (24e36 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 40þ26months for Cohort-I vs. 54þ34months 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 7þ8months for Cohort-I vs. 14þ20months 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".