Of the 482 children included in the analysis, 434 were female (90%), 375 were white (78%), and 375 had
vesicoureteral reflux (78%). The median age was 11 months. A total of 35 children (7.2%) developed new renal
scarring. Delay in the initiation of antimicrobial
therapy was associated with renal
scarring; the median (25th, 75th percentiles) duration of
fever prior to initiation of
antibiotic therapy in those with and without renal
scarring was 72 (30, 120) and 48 (24, 72) hours, respectively (P = .003). Older age (OR, 1.03; 95% CI, 1.01-1.05), Hispanic ethnicity (OR, 5.24; 95% CI, 2.15-12.77), recurrent
urinary tract infections (OR, 0.97; 95% CI, 0.27-3.45), and bladder and bowel dysfunction (OR, 6.44; 95% CI, 2.89-14.38) were also associated with new renal
scarring. Delay in the initiation of antimicrobial
therapy remained significantly associated with renal
scarring even after adjusting for these variables.
CONCLUSIONS AND RELEVANCE: Delay in treatment of febrile UTIs and permanent renal
scarring are associated. In febrile children, clinicians should not delay testing for UTI.