SynthesisPediatric nephrology (Berlin, Germany)2026
A novel clinical score to predict breakthrough urinary tract infection in children with VUR: meta-analytic derivation and real-world validation.
Synthesis in Pediatric nephrology (Berlin, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBreakthrough urinary tract infection (BT-UTI) among children with vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP) remains a clinical challenge with heterogeneous risk profiles and no validated prediction tools. We aimed to identify robust risk factors and develop an evidence-based predictive score for BT-UTI.
methodsWe conducted a systematic review and meta-analysis following PRISMA and Cochrane guidance, searching PubMed, Web of Science, and Embase for cohort studies. Pooled effect estimates were calculated using appropriate fixed- or random-effects models; a scoring system was derived by natural logarithm transformation of pooled estimates. External validation used a cohort of 158 children with VUR receiving CAP at Children's Hospital of Chongqing Medical University (2021-2024).
resultsTwenty-four cohort studies (n = 3,264) were included; pooled BT-UTI incidence was 30.5%. From 26 candidate factors, eight stable predictors were retained and incorporated into the score: age < 1 year (OR 2.04), bilateral reflux (OR 1.81), high-grade reflux IV-V (OR 2.65), symptomatic UTI (OR 2.74), history of recurrent UTI (OR 2.17), bladder and bowel dysfunction (BBD; OR 1.81), increased ureteral diameter ratio (UDR; MD 0.139), and DMSA renal scar formation (OR 4.40). External validation showed AUC 0.88 (95% CI 0.82-0.93); at a cutoff of 17 points accuracy was 0.84, and sensitivity 0.93. Calibration and decision-curve analyses indicated good agreement and a positive net clinical benefit.
conclusionsWe developed and externally validated an eight-item BT-UTI risk score for children with VUR on CAP that demonstrates high discrimination and clinical utility for individualized risk stratification and prevention planning and implementation guidance available.
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