Association between vesicoureteral reflux, urinary tract infection and antibiotics exposure in infancy and risk of childhood asthma

• Published in: PloS one Vol. 16; no. 9; p. e0257531
• Main Authors: Hsu, Yu-Lung, Lin, Cheng-Li, Wei, Chang-Ching
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 21.09.2021; Public Library of Science (PLoS)
• Subjects: Age; Ambulatory care; Antibiotics; Asthma; Asthma in children; Babies; Biology and Life Sciences; Birth weight; Bladder; Bladder diseases; Childhood; Children; Childrens health; Complications and side effects; Confidence intervals; Diagnosis; Disease prevention; Earth Sciences; Health aspects; Health insurance; Health risks; Hospitals; Infants; Infections; Medicine and Health Sciences; Pediatrics; People and Places; Population; Population studies; Risk; Social Sciences; Statistical models; Urbanization; Urinary tract; Urinary tract diseases; Urinary tract infections; Urogenital system; Viral infections; Taiwan; China
• DOI: 10.1371/journal.pone.0257531
• ISSN: 1932-6203

The use of antibiotics for treating infection in childhood and their association with increased risk of asthma remain controversial. Infants diagnosed with vesicoureteral reflux (VUR) belong to a unique population who are administered antibiotics for a long time and are susceptible to recurrent UTI. It is interesting to study the risk of asthma in these infants with or without VUR. Taiwanese children born between 2000 and 2007 were enrolled in population-based birth cohort study. Participants diagnosed with VUR and UTI within first year were classified into four groups (VUR, UTI, VUR and UTI, and control). We calculated follow-up person-years for each participant from the index date until the asthma diagnosis, their withdrawal from the insurance system (because of death or loss to follow-up), or till the end of 2008. The risk of asthma was compared between the 4 cohorts by using Cox proportional hazards model analysis, adjusted hazard ratio (aHR), and 95% confidence interval (95% CI). Children diagnosed with VUR (n = 350), UTI (n = 15542), VUR and UTI (n = 1696), and randomly selected controls (n = 17588) were enrolled. The overall rate of incidence of asthma was found to be 1.64-fold, 1.45-fold, and 1.17-fold higher in the UTI, VUR/UTI, and VUR cohorts than in the controls (5.60, 5.07, and 4.10 vs. 3.17 per 100 person-years), respectively. After adjusting the potential factors, the overall risk of asthma remained the highest in UTI (aHR: 1.74, 95% CI : 1.65 to 1.80) followed by VUR/UTI (aHR: 1.56, 95% CI : 1.40 to 1.75) and VUR cohorts (aHR: 1.25, 95% CI: 0.96 to 1.62). The incidence of asthma was higher in boys than in girls. The nationwide retrospective cohort study demonstrated that short-term therapeutic dose of antibiotics for UTI in infants with or without VUR has a positive correlation with the prevalence of childhood asthma. Significant risk of childhood asthma was not observed when VUR cohort was exposed to long-term low-dose of prophylactic antibiotics.