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- Brandström, Per, 1959, et al.
(författare)
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Swedish Reflux Trial in Children - Pattern of Urinary Tract Infections
- 2010
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Ingår i: European Society for Paediatric Urology Annual Meeting, 28 april-1 maj 2010, Antalya, Turkiet.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- PURPOSE To evaluate the difference in rate of febrile urinary tract infection in small children with dilating vesicoureteral reflux, randomly allocated to 3 management alternatives: antibiotic prophylaxis, endoscopic treament, or surveillance only (control group). MATERIAL AND METHODS From 23 centers, a total of 203 children were included, 128 girls and 75 boys aged 1 to less than 2 years. Vesicoureteral reflux grade III (n=126) or IV (n=77) was detected after a febrile urinary tract infection in 194 and after antenatal screening in 9. Voiding cystourethrography and dimercaptosuccinic acid scintigraphy were performed before randomization and after 2 years. The rate of symptomatic febrile urinary tract infections was analyzed according to the intention-to-treat principle. RESULTS There were 67 febrile recurrences in 42 girls and 8 recurrences in 7 boys (p=0.0001). There was a difference in recurrence rate between the treatment groups in girls, were febrile infection was seen in 8 of 43 (19%) girls in the prophylaxis, 10 of 43 (23%) in the endoscopic, and 24 of 42 (57%) in the surveillance group (p=0.0002). In girls there was no difference in recurrence rate between those with grade III and IV reflux at entry, but recurrence was associated with reflux grade at follow-up (p=0.0095). CONCLUSIONS In this randomized controlled trial there was a high rate of recurrent febrile urinary tract infections in girls over the age of 1 year with dilating vesicoureteral reflux, but not in boys. Both antibiotic prophylaxis and endoscopic treatment reduced the rate of infections.
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| 2. |
- Brandström, Per, 1959, et al.
(författare)
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The Swedish Reflux Trial in Children: I. Study Design and Study Population Characteristics
- 2010
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 184:1, s. 274-279
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Konferensbidrag (refereegranskat)abstract
- Purpose: We compared the rates of febrile urinary tract infection, kidney damage and reflux resolution in children with vesicoureteral reflux treated in 3 ways, including antibiotic prophylaxis, endoscopic therapy and surveillance with antibiotics only for symptomatic urinary tract infection. Materials and Methods: Children 1 to younger than 2 years with grade reflux were recruited into this prospective, open, randomized, controlled, multi-center study and followed for 2 years after randomization. The main study end points were recurrent febrile urinary tract infection, renal status on dimercaptosuccinic acid scintigraphy and reflux status. Outcomes were analyzed by the intent to treat principle. Results: During a 6-year period 128 girls and 75 boys entered the study. In 96% of cases reflux was detected after urinary tract infection. The randomization procedure was successful and resulted in 3 groups matched for relevant factors. Recruitment was slower than anticipated but after patients were entered adherence to the protocol was good. Of the children 93% were followed for the intended 2 years without a treatment arm change. All except 2 patients completed 2-year followup scintigraphy. Conclusions: Recruitment was difficult but a substantial number of children were entered and randomly assigned to 3 groups with similar basic characteristics. Good adherence to the protocol made it possible to address the central study questions.
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| 3. |
- Brandström, Per, 1959, et al.
(författare)
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The Swedish Reflux Trial in Children: III. Urinary Tract Infection Pattern.
- 2010
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Ingår i: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 184:1, s. 286-291
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We evaluated the difference in the febrile urinary tract infection rate in small children with dilating vesicoureteral reflux randomly allocated to 3 management alternatives, including antibiotic prophylaxis, endoscopic treatment or surveillance only as the control. MATERIALS AND METHODS: At 23 centers a total of 203 children were included in the study, including 128 girls and 75 boys 1 to younger than 2 years. Vesicoureteral reflux grade III in 126 cases and IV in 77 was detected after a febrile urinary tract infection (194) after prenatal screening (9). Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years. The febrile urinary tract infection rate was analyzed by the intent to treat principle. RESULTS: We noted a total of 67 febrile recurrences in 42 girls and a total of 8 in 7 boys (p = 0.0001). There was a difference in the recurrence rate among treatment groups in girls with febrile infection in 8 of 43 (19%) on prophylaxis, 10 of 43 (23%) with endoscopic therapy and 24 of 42 (57%) on surveillance (p = 0.0002). In girls the recurrence rate was associated with persistent reflux after 2 years (p = 0.0095). However, reflux severity (grade III or IV) at study entry did not predict recurrence. CONCLUSIONS: In this randomized, controlled trial there was a high rate of recurrent febrile urinary tract infection in girls older than 1 year with dilating vesicoureteral reflux at study entry but not in boys. Antibiotic prophylaxis and endoscopic treatment decreased the infection rate.
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