Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring.

Abstract

OBJECTIVES:

To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis.

METHODS:

This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring.

RESULTS:

Children with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09-3.93]) and presence of renal scarring on the baseline (99m)Tc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22-6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86-4.87]).

CONCLUSIONS:

VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD.

• Authors: Ron Keren, Nader Shaikh, Hans Pohl, Lisa Gravens-Mueller, Anastasia Ivanova, Lisa Zaoutis, Melissa Patel, Rachel deBerardinis, Allison Parker, Sonika Bhatnagar, Mary Ann Haralam, Marcia Pope, Diana Kearney, Bruce Sprague, Raquel Barrera, Bernarda Viteri, Martina Egigueron, Neha Shah, Alejandro Hoberman
• Journal: Pediatrics (Pediatrics) Vol. 136 Issue 1 Pg. e13-21 (Jul 2015) ISSN: 1098-4275 [Electronic] United States
• PMID: 26055855 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2015 by the American Academy of Pediatrics.

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Antibiotic Prophylaxis (methods)
• Child, Preschool
• Cicatrix (epidemiology, etiology, pathology)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Infant
• Kidney (pathology)
• Male
• Prospective Studies
• Recurrence
• Risk Assessment (methods)
• Risk Factors
• United States (epidemiology)
• Urinary Tract Infections (complications, drug therapy, epidemiology)
• Vesico-Ureteral Reflux (complications, diagnosis)