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Randomized Controlled Trial
. 2015 Jul;136(1):e13-21.
doi: 10.1542/peds.2015-0409. Epub 2015 Jun 8.

Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring

Ron Keren  1 , Nader Shaikh  2 , Hans Pohl  3 , Lisa Gravens-Mueller  4 , Anastasia Ivanova  4 , Lisa Zaoutis  5 , Melissa Patel  5 , Rachel deBerardinis  5 , Allison Parker  5 , Sonika Bhatnagar  2 , Mary Ann Haralam  2 , Marcia Pope  2 , Diana Kearney  2 , Bruce Sprague  3 , Raquel Barrera  3 , Bernarda Viteri  3 , Martina Egigueron  3 , Neha Shah  3 , Alejandro Hoberman  2
Affiliations
Randomized Controlled Trial

Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring

Ron Keren et al. Pediatrics. 2015 Jul.

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.

Trial registration: ClinicalTrials.gov NCT00405704.

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Figures

FIGURE 1
FIGURE 1
aChildren were enrolled at various clinical sites (emergency and radiology departments and primary care, urology, and nephrology offices), resulting in diverse criteria for screening (eg, abnormal urinalysis results, positive urine culture). VCUG, voiding cystourethrogram.
FIGURE 2
FIGURE 2
Time to first recurrent febrile or symptomatic UTI. Kaplan-Meier estimates are displayed of the cumulative percentage of children who had a recurrent febrile or symptomatic UTI according to presence or absence of VUR. Fewer children in the no VUR group had a recurrent UTI than children in the group with VUR (P = .045 by log-rank test). Bars indicate 95% CIs.
See this image and copyright information in PMC

References

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