New model predicts febrile UTI in children with VUR after CAP discontinuation

Select children with persistent vesicoureteral reflux (VUR), especially those without voiding dysfunction, may choose to suspend continuous antibiotic prophylaxis (CAP), suggests a study, noting that a predictive monogram can aid in individualized decision-making.

The authors identified children managed with CAP who subsequently discontinued prophylaxis through a retrospective review of an institutional VUR registry (2012-2018). Those with secondary VUR, underlying anatomic abnormalities, or inadequate follow-up were excluded.

The authors analysed demographics, outcomes, and clinical characteristics and identified predictors of post-cessation febrile urinary tract infection (fUTI) using a multivariable Cox proportional hazards model. They also constructed a nomogram.

Using the concordance index (C index) and time dependent area under the ROC curve (AUC), the authors evaluated model performance. They then developed and validated a simplified clinical risk score.

A total of 876 children had primary VUR, of whom 386 (44 percent) discontinued CAP without voiding cystourethrogram-confirmed resolution. The median age at cessation was 39 months, while the median follow-up duration was 44 months.

Among children who discontinued CAP, 345 (89 percent) remained free of fUTI, while 41 (11 percent) developed the condition. In multivariate analysis, bowel and bladder dysfunction (hazard ratio [HR], 16.1; p<0.001) and high-grade VUR (HR, 2.21; p=0.02) were independently associated with the risk of developing fUTI.

The nomogram had a C index of 0.77 and AUCs of 0.67 at 1 year, 0.80 at 3 years, and 0.77 at 5 years. The simplified 3-year risk score stratified patients into low (n=305), moderate (n=66), and high (n=15) risk groups with good discrimination (C index, 0.75; log-rank p<0.001).

“Prospective studies are warranted to refine risk stratification and optimize management strategies,” the authors said.