Uropathogen resistance and antibiotic prophylaxis: A meta-analysis

Rachel E. Selekman, Daniel J. Shapiro, John W. Boscardin, Gabrielle J. Williams, Jonathan C. Craig, Per Brandström, Marco Pennesi, Gwénaëlle Roussey-Kesler, Pankaj Hari, Hillary Lynne Copp

Research output: Contribution to journalReview articlepeer-review

36 Citations (Scopus)


CONTEXT: Limited data exist regarding uropathogen resistance in randomized controlled trials of urinary tract infection (UTI) prevention and antibiotic prophylaxis. OBJECTIVE: To assess the effect of prophylaxis on developing a multidrug-resistant first recurrent UTI among children with vesicoureteral reflux. DATA SOURCES: Cochrane Kidney and Transplant Specialized Register through May 25, 2017. STUDY SELECTION: Randomized controlled trials of patients ≤18 years of age with a history of vesicoureteral reflux being treated with continuous antibiotic prophylaxis compared with no treatment or placebo with available antibiotic sensitivity profiles. DATA EXTRACTION: Two independent observers abstracted data and assessed quality and validity per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Adjusted meta-analyses were performed by using a mixed-effects logistic regression model. RESULTS: One thousand two hundred and ninety-nine patients contributed 224 UTIs. Patients treated with prophylaxis were more likely to have a multidrug-resistant infection (33% vs 6%, P <. 001) and were more likely to receive broad-spectrum antibiotics (68% vs 49%, P =. 004). Those receiving prophylaxis had 6.4 times the odds (95% confidence interval: 2.7-15.6) of developing a multidrug-resistant infection. One multidrug-resistant infection would develop for every 21 reflux patients treated with prophylaxis. LIMITATIONS: Variables that may contribute to resistance such as medication adherence and antibiotic exposure for other illnesses could not be evaluated. CONCLUSIONS: Prophylaxis increases the risk of multidrug resistance among recurrent infections. This has important implications in the risk-benefit assessment of prophylaxis as a management strategy and in the selection of empirical treatment of breakthrough infections in prophylaxis patients.

Original languageEnglish
Article numbere20180119
Number of pages8
Issue number1
Publication statusPublished - Jul 2018
Externally publishedYes


  • Urology
  • Infectious disease
  • Urinary tract infection (UTI)
  • antibiotic resistance
  • Antibiotic prophylaxis


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