A Risk Stratification Model to Predict Febrile Urinary Tract Infection After Cessation of Continuous Antibiotic Prophylaxis in Children with Known Vesicoureteral Reflux

No AccessJournal of UrologyPediatric Article10 Oct 2025A Risk Stratification Model to Predict Febrile Urinary Tract Infection After Cessation of Continuous Antibiotic Prophylaxis in Children with Known Vesicoureteral Reflux Suhaib Abdulfattah, MD Nicole J. Kye, BA Avi P. Shah, BS Sahar Eftekharzadeh, MD MPH Marina Quairoli, BS Emily Ai, BS Karl Godlewski, MD Katherine Fischer, MD Dana Weiss, MD Jason P. Van Batavia, MD MSTR Christopher J. Long, MD Stephen A. Zderic, MD Mark Zaontz, MD Thomas F. Kolon, MD Sameer Mittal, MD MSc Arun K. Srinivasan, andMD MRCS Aseem R. ShuklaMD MHCI Suhaib AbdulfattahSuhaib Abdulfattah Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Nicole J. KyeNicole J. Kye Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Avi P. ShahAvi P. Shah Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Sahar EftekharzadehSahar Eftekharzadeh Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Marina QuairoliMarina Quairoli Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Emily AiEmily Ai Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Karl GodlewskiKarl Godlewski Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Katherine FischerKatherine Fischer Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Dana WeissDana Weiss Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Jason P. Van BataviaJason P. Van Batavia Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Christopher J. LongChristopher J. Long Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Stephen A. ZdericStephen A. Zderic Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Mark ZaontzMark Zaontz Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Thomas F. KolonThomas F. Kolon Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Sameer MittalSameer Mittal Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , Arun K. SrinivasanArun K. Srinivasan Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA , and Aseem R. ShuklaAseem R. Shukla Corresponding author: Aseem R Shukla Director, Minimally Invasive Surgery Children's Hospital of Philadelphia Urology 34th Street and Civic Center Blvd., 337 Laurel Lane, Philadelphia, PA 19104, United States, Ph: +12155907889 Fax: +12155903985 Email: (email protected) View All Author Informationhttps://doi.org/10.1097/JU.0000000000004815AboutPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose This study evaluates the clinical characteristics and predictors of febrile urinary tract infection in children with potentially persistent primary vesicoureteral reflux (VUR) who discontinued continuous antibiotic prophylaxis (CAP) without radiographic confirmation of reflux resolution. We hypothesize that many patients can safely discontinue CAP after toilet training and that a nomogram can predict the probability of febrile urinary tract infection (fUTI) following cessation. Materials and Methods A retrospective review of an institutional VUR registry (2012–2018) identified children managed with CAP who subsequently discontinued prophylaxis. Patients with secondary VUR, underlying anatomic abnormalities, or inadequate follow-up were excluded. Demographics, clinical characteristics, and outcomes were analyzed. Multivariable Cox proportional hazards modeling identified predictors of post-cessation fUTI, and a nomogram was constructed. Model performance was evaluated using the concordance index (C-index) and time-dependent AUC (area under the ROC curve). A simplified clinical risk score was developed and validated. Results Among 876 children with primary VUR, 386 (44%) discontinued CAP without VCUG-confirmed resolution. Median age at cessation was 39 months, with a median follow-up of 44 months. Post-cessation, 345 (89%) remained free of fUTI; 41 (11%) developed fUTI. Multivariable analysis identified bowel and bladder dysfunction (HR=16.1, p<0.001) and high-grade VUR (HR=2.31, p=0.02) as independent risk factors for fUTI. The nomogram demonstrated a C-index of 0.77 and AUCs of 0.67, 0.80, and 0.77 at 1-, 3-, and 5-years, respectively. A 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). Conclusions CAP discontinuation is a viable strategy in select children with persistent VUR, particularly those without voiding dysfunction. A predictive nomogram provides a valuable tool for individualized decision-making. Prospective studies are warranted to refine risk stratification and optimize management strategies. © 2025 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2025 by American Urological Association Education and Research, Inc.Keywordsvesicoureteral refluxnomogramprediction modelfebrile urinary tract infection Author Information Suhaib Abdulfattah Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Nicole J. Kye Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Avi P. Shah Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Sahar Eftekharzadeh Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Marina Quairoli Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Emily Ai Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Karl Godlewski Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Katherine Fischer Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Dana Weiss Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Jason P. Van Batavia Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Christopher J. Long Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Stephen A. Zderic Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Mark Zaontz Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Thomas F. Kolon Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Sameer Mittal Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Arun K. Srinivasan Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA More articles by this author Aseem R. Shukla Corresponding author: Aseem R Shukla Director, Minimally Invasive Surgery Children's Hospital of Philadelphia Urology 34th Street and Civic Center Blvd., 337 Laurel Lane, Philadelphia, PA 19104, United States, Ph: +12155907889 Fax: +12155903985 Email: (email protected) More articles by this author Expand All Advertisement PDF downloadLoading ...