Factors Associated with Abnormal Imaging and Infection Recurrence after a First Febrile Urinary Tract Infection in Children

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Abstract

Introduction

We determined factors associated with abnormal imaging and recurrent infections after a first febrile urinary tract infection (UTI) in children younger than 3 years.

Materials and Methods

We retrospectively reviewed the records of all patients treated at our institute during the years 2000–2009, for a first febrile UTI in children younger than 3 years, who underwent ultrasonography and voiding cystourethrography. We evaluated data regarding factors potentially associated with abnormal ultrasonography and voiding cystourethrography results and recurrence of infections, and formulated a risk score system to assess risk of reflux and high-grade reflux.

Results

There were 282 patients. The only factor predicting abnormal ultrasonogram was non-Escherichia coli infection. Risk factors for vesicoureteral reflux included abnormal ultrasonogram, atypical infection, non-E. coli infection and infection recurrence. Patients with no identified risk factors for vesicoureteral reflux were unlikely to have high-grade reflux. Higher risk scores were associated with a higher risk for reflux. Non-E. coli infection was the only statistically significant predictor of infection recurrence.

Conclusion

All children younger than 3 years with first febrile UTI should undergo ultrasonography. Thereafter, patients with no predictive factors for vesicoureteral reflux may be followed up without further imaging. A non-E. coli infection is associated with reflux and infection recurrence.

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