Caleb P Nelson1, Alejandro Hoberman2, Nader Shaikh2, Ron Keren3, Ranjiv Mathews4, Saul P Greenfield5, Tej K Mattoo6, Nathan Gotman7, Anastasia Ivanova7, Marva Moxey-Mims8, Myra A Carpenter7, Russell W Chesney9. 1. Department of Urology, Boston Children's Hospital, Boston, Massachusetts; caleb.nelson@childrens.harvard.edu. 2. Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; 3. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 4. Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland; 5. Department of Pediatric Urology, Women & Children's Hospital of Buffalo, Buffalo, New York; 6. Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan; 7. Department of Biostatistics, The University of North Carolina, Chapel Hill, North Carolina; 8. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; 9. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Abstract
BACKGROUND: 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 trimethoprim-sulfamethoxazole prophylaxis (TSP) arm. We describe factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) resistance of rUTIs in RIVUR. METHODS:Children aged 2 to 71 months with first or second UTI (index UTI) and grade I to IV vesicoureteral reflux (VUR) were randomized to TSP 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 of 278 children receiving TSP versus 67 of 293 children receiving placebo. Among those with rUTI, 76% (26/34) of subjects receiving TSP had TMP-SMX-resistant organisms versus 28% (19/67) of subjects receiving placebo (P < .001). The proportion of TMP-SMX-resistant rUTI decreased over time: in the TSP arm, 96% were resistant during the initial 6 months versus 38% resistant during the final 6 months; corresponding proportions for the placebo arm were 32% and 11%. Among children receiving TSP, 7 (13%) of 55 with TMP-SMX-resistant index UTI had rUTI, whereas 27 (12%) of 223 with TMP-SMX-susceptible index UTI had rUTI (adjusted hazard ratio 1.38, 95% confidence interval 0.54-3.56). Corresponding proportions in placebo arm were 17 (26%) of 65 and 50 (22%) of 228 (adjusted hazard ratio 1.33, 95% confidence interval 0.74-2.38). CONCLUSIONS: Although TMP-SMX resistance is more common among children treated with TSP versus placebo, resistance decreased over time. Among children treated with TSP, there was no significant difference in UTI recurrence between those with TMP-SMX-resistant index UTI versus TMP-SMX-susceptible UTI.
RCT Entities:
BACKGROUND: 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 trimethoprim-sulfamethoxazole prophylaxis (TSP) arm. We describe factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) resistance of rUTIs in RIVUR. METHODS:Children aged 2 to 71 months with first or second UTI (index UTI) and grade I to IV vesicoureteral reflux (VUR) were randomized to TSP 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 of 278 children receiving TSP versus 67 of 293 children receiving placebo. Among those with rUTI, 76% (26/34) of subjects receiving TSP had TMP-SMX-resistant organisms versus 28% (19/67) of subjects receiving placebo (P < .001). The proportion of TMP-SMX-resistant rUTI decreased over time: in the TSP arm, 96% were resistant during the initial 6 months versus 38% resistant during the final 6 months; corresponding proportions for the placebo arm were 32% and 11%. Among children receiving TSP, 7 (13%) of 55 with TMP-SMX-resistant index UTI had rUTI, whereas 27 (12%) of 223 with TMP-SMX-susceptible index UTI had rUTI (adjusted hazard ratio 1.38, 95% confidence interval 0.54-3.56). Corresponding proportions in placebo arm were 17 (26%) of 65 and 50 (22%) of 228 (adjusted hazard ratio 1.33, 95% confidence interval 0.74-2.38). CONCLUSIONS: Although TMP-SMX resistance is more common among children treated with TSP versus placebo, resistance decreased over time. Among children treated with TSP, there was no significant difference in UTI recurrence between those with TMP-SMX-resistant index UTI versus TMP-SMX-susceptible UTI.
Authors: Alejandro Hoberman; Saul P Greenfield; Tej K Mattoo; Ron Keren; Ranjiv Mathews; Hans G Pohl; Bradley P Kropp; Steven J Skoog; Caleb P Nelson; Marva Moxey-Mims; Russell W Chesney; Myra A Carpenter Journal: N Engl J Med Date: 2014-05-04 Impact factor: 91.245
Authors: Jonathan C Craig; Judy M Simpson; Gabrielle J Williams; Alison Lowe; Graham J Reynolds; Steven J McTaggart; Elisabeth M Hodson; Jonathan R Carapetis; Noel E Cranswick; Grahame Smith; Les M Irwig; Patrina H Y Caldwell; Sana Hamilton; Leslie P Roy Journal: N Engl J Med Date: 2009-10-29 Impact factor: 91.245
Authors: Eduardo H Garin; Fernando Olavarria; Victor Garcia Nieto; Blanca Valenciano; Alfonso Campos; Linda Young Journal: Pediatrics Date: 2006-03 Impact factor: 7.124
Authors: Ron Keren; Myra A Carpenter; Alejandro Hoberman; Nader Shaikh; Tej K Matoo; Russell W Chesney; Ranjiv Matthews; Arlene C Gerson; Saul P Greenfield; Barbara Fivush; Gordon A McLurie; H Gil Rushton; Douglas Canning; Caleb P Nelson; Lawrence Greenbaum; Timothy Bukowski; William Primack; Richard Sutherland; James Hosking; Dawn Stewart; Jack Elder; Marva Moxey-Mims; Leroy Nyberg Journal: Pediatrics Date: 2008-12 Impact factor: 7.124
Authors: Myra A Carpenter; Alejandro Hoberman; Tej K Mattoo; Ranjiv Mathews; Ron Keren; Russell W Chesney; Marva Moxey-Mims; Saul P Greenfield Journal: Pediatrics Date: 2013-06-10 Impact factor: 7.124
Authors: G Roussey-Kesler; V Gadjos; N Idres; B Horen; L Ichay; M D Leclair; F Raymond; A Grellier; I Hazart; L de Parscau; R Salomon; G Champion; V Leroy; V Guigonis; D Siret; J B Palcoux; S Taque; A Lemoigne; J M Nguyen; C Guyot Journal: J Urol Date: 2007-12-20 Impact factor: 7.450
Authors: Sebastiaan Hermanus Johannes Zegers; Jeanne Dieleman; Tjomme van der Bruggen; Jan Kimpen; Catharine de Jong-de Vos van Steenwijk Journal: BMC Infect Dis Date: 2017-01-12 Impact factor: 3.090
Authors: Kristopher T Kang; Karen Ng; Jennifer Kendrick; Peter Tilley; Joseph Ting; Shahrad Rassekh; Srinivas Murthy; Ashley Roberts Journal: Paediatr Child Health Date: 2019-02-05 Impact factor: 2.253
Authors: Karyom Djim-Adjim-Ngana; Leila Aïcha Oumar; Brunel Wanda Mbiakop; Hermann Landry Munshili Njifon; Tania Crucitti; Elias Nukenine Nchiwan; Nicolas Njintang Yanou; Louis Deweerdt Journal: Pan Afr Med J Date: 2020-07-06