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Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: systematic review and meta-analysis.

ABSTRACT: Controversy exists regarding the use of continuous antibiotic prophylaxis vs observation in the management of children with vesicoureteral reflux. The reported effectiveness of continuous antibiotic prophylaxis in children with reflux varies widely. We determined whether the aggregated evidence supports use of continuous antibiotic prophylaxis in children with vesicoureteral reflux.We searched the Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE(®), EMBASE(®), Google Scholar and recently presented meeting abstracts for reports in any language. Bibliographies of included studies were then hand searched for any missed articles. The study protocol was prospectively registered at PROSPERO (No. CRD42014009639). Reports were assessed and data abstracted in duplicate, with differences resolved by consensus. Risk of bias was assessed using standardized instruments.We identified 1,547 studies, of which 8 are included in the meta-analysis. Pooled results demonstrated that continuous antibiotic prophylaxis significantly reduced the risk of recurrent febrile or symptomatic urinary tract infection (pooled OR 0.63, 95% CI 0.42-0.96) but, if urinary tract infection occurred, increased the risk of antibiotic resistant organism (pooled OR 8.75, 95% CI 3.52-21.73). A decrease in new renal scarring was not associated with continuous antibiotic prophylaxis use. Adverse events were similar between the 2 groups. Significant heterogeneity existed between studies (I(2) 50%, p = 0.03), specifically between those trials with significant risk of bias (eg unclear protocol descriptions and/or lack of blinding).Compared to no treatment, continuous antibiotic prophylaxis significantly reduced the risk of febrile and symptomatic urinary tract infections in children with vesicoureteral reflux, although it increased the risk of infection due to antibiotic resistant bacteria. Continuous antibiotic prophylaxis did not significantly impact the occurrence of new renal scarring or reported adverse events.

SUBMITTER: Wang HH

PROVIDER: S-EPMC4380260 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: systematic review and meta-analysis.

Wang Hsin-Hsiao S HH Gbadegesin Rasheed A RA Foreman John W JW Nagaraj Shashi K SK Wigfall Delbert R DR Wiener John S JS Routh Jonathan C JC

The Journal of urology 20140906 3

<h4>Purpose</h4>Controversy exists regarding the use of continuous antibiotic prophylaxis vs observation in the management of children with vesicoureteral reflux. The reported effectiveness of continuous antibiotic prophylaxis in children with reflux varies widely. We determined whether the aggregated evidence supports use of continuous antibiotic prophylaxis in children with vesicoureteral reflux.<h4>Materials and methods</h4>We searched the Cochrane Controlled Trials Register, clinicaltrials.g ...[more]

PMID: 25196653

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Project description:Introduction: Urinary tract infection (UTI) in children leads to renal scarring in 10-15% of patients. Urinary tract anomalies and bladder and bowel dysfunction (BBD) are documented risk factors for recurrent UTIs. Estimates of baseline prevalence of BBD in children with UTI will help the clinician in the management strategy. Hence, a systematic review and meta-analysis was conducted to estimate the pooled prevalence of BBD. Methods: MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) databases were searched for articles related to UTI, primary vesicoureteral reflux (VUR), and BBD. We included studies that provided prevalence of BBD in toilet-trained patients aged 1-18 years with UTI and/or VUR. BBD was defined based on clinical history or questionnaire or urodynamic studies. Two authors independently reviewed, assessed, and abstracted data from studies. Pooled prevalence was calculated based on a random effects model. Results: Forty-three studies fulfilling the eligibility criteria were selected from a total of 1,731 studies. Among patients presenting with UTI without primary VUR, pooled prevalence of BBD was 41% (95% CI: 26-55; nine studies, 920 patients, I 2 = 96.0%), whereas its prevalence in patients with primary VUR was 49% (43-56; 30 studies, 5,060 patients, I 2 = 96.0%). Weighting by the study design and quality did not affect the prevalence. In patients with primary VUR, prevalence of BBD was higher in females (53%; 42-65) than in males (44%; 15-73). In studies where urodynamic study was used for the diagnosis of BBD, prevalence was 63%. The presence of BBD in patients with primary VUR increased risk of recurrent UTIs [relative risk (RR): 2.1; 1.7-2.5]. In five studies that reported separate data on constipation, pooled prevalence of constipation was 27% (16-37). Conclusion: Almost half of the patients with primary VUR have BBD, and its presence increases the risk of recurrent UTIs. Trends of high BBD prevalence were also observed in patients presenting with UTI without VUR. These prevalence estimates suggest that all toilet-trained children presenting with UTI with or without VUR should be assessed for BBD, which will help in their further management.

Project description:ImportanceAlthough antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed.ObjectiveTo systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis.Data sourcesMEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science were searched with prospectively designed search phrases on February 16, 2018. All databases were searched from database inception. Key search terms included rhinoplasty, nasal valve repair, and antibacterial agent.Study selectionRandomized clinical trials (RCTs) with adults (≥18 years) undergoing rhinoplasty and including systemic antibiotic medications administered in the absence of other reasons for use of an antibiotic (eg, localized or systemic infection), without restrictions on language or the time of publication, were included in the study. Interventions of interest were classified into 3 types: (1) single-dose systemic antibiotic administered within 24 hours before the first incision, (2) multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and (3) systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision. The following comparisons were made: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1.Data extraction and synthesisData extraction was compliant with PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Two independent reviewers assessed the relevance of the remaining records at abstract and full-text stages. Meta-analysis pooled with random-effects model.Main outcomes and measuresDifference in infectious complication rate between groups.ResultsA total of 262 records were identified; of these, only 5 RCTs fulfilled predetermined population, intervention, comparison, and outcome criteria. The pooled study sample consisted of 589 participants. No significant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively were found, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P = .86).Conclusions and relevanceThis study appears to be the first Cochrane-protocol systematic review and meta-analysis investigating preventive antibiotics in rhinoplasty. This study's results suggest that pooled evidence from the 5 RCTs does not support the use of preventive antibiotic therapy in rhinoplasty.Level of evidence1.

Project description:IntroductionThere is little evidence-based guidance on the use of prophylactic antibiotics in skin surgery; whilst antibiotics may protect against surgical site infections (SSI), they have associated side effects, increase the risk of adverse events, and can propagate antibiotic resistance. We present a protocol for a systematic review to establish whether the benefit of prophylactic antibiotics overrides the risk, for patients undergoing autograft surgery.MethodsThe systematic review will be registered a priori on researchregistry.com and will be conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A search strategy will be devised to investigate 'skin graft surgery and use of antibiotics'. The following electronic databases will be searched, 1979-2018: PubMed, MEDLINE®, EMBASE, SCOPUS, CINAHL, PsychINFO, SciELO, The Cochrane Library, including the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effect (DARE), the Cochrane Methodology Register, Health Technology Assessment Database, the NHS Economic Evaluation Databases and Cochrane Groups, ClinicalTrials.gov, Current Controlled Trials Database, the World Health Organisation (WHO) International Clinical Trials Registry Platform, UpToDate.com, NHS Evidence and the York Centre for Reviews and Dissemination. Grey literature will be searched. All comparative study designs reporting on the use of antibiotics in skin graft surgery will be considered for inclusion, namely randomized controlled trials (RCTs). Two trained independent teams will screen all titles and abstracts, followed by relevant full texts, for eligibility. Data will be extracted under standardized extraction fields into a preformatted database. Note will be made of the indication for skin graft surgery (traumatic, congenital, malignant, benign), the graft site (head & neck, trunk, upper extremities, lower extremities), type of skin graft (split thickness, full-thickness). The primary outcome will be occurrence of SSI at the donor and/or recipient sites. Secondary outcomes, if reported, will include: length of hospital stay, revision surgery required, cost of medical care, time to wound healing and cosmetic outcome.Ethics and disseminationThe systematic review will be published in a peer-reviewed journal and presented at national and international meetings within fields of plastic, reconstructive, and aesthetic surgery. The work will be disseminated electronically and in print. Brief reports of the review and findings will be disseminated to interested parties through email and direct communication. The review aims to guide healthcare practice and policy.

Dataset Information

Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: systematic review and meta-analysis.

Publications

Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: systematic review and meta-analysis.

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