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Risk factors for recurrent urinary tract infection in preschool children
K Panaretto1, J Craig, J Knight
1The Centre for Kidney Research, Australia. PanaretK@health.qld.gov.au
Insights
Young children under 6 months and those with grade 3-5 vesicoureteric reflux (VUR) are at higher risk for recurrent urinary tract infections (UTI). Early identification and targeted management can prevent kidney scarring.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTI) in children can lead to renal scarring, impaired kidney function, and hypertension.
- Identifying risk factors for recurrent UTI is crucial for preventing long-term renal damage.
Purpose of the Study:
- To examine risk factors for recurrent UTI in children under 5 years.
- To investigate the association between recurrent UTI and renal scarring.
Main Methods:
- Prospective study of 290 children under 5 with a first symptomatic UTI.
- Micturating cystourethrogram and DMSA renal scintigraphy performed at entry and 1-year follow-up.
- 90% follow-up rate at 1 year.
Main Results:
- Recurrent UTI occurred in 12% of children; multiple recurrences in 34% of those with recurrence.
- Age < 6 months (OR: 2.9) and grade 3-5 VUR (OR: 3.5) independently predicted recurrent UTI.
- Recurrent UTI was associated with DMSA defects and new renal parenchymal defects at 1 year.
Conclusions:
- Independent risk factors for recurrent UTI in children are age < 6 months and grade 3-5 VUR.
- Selective targeting of prophylaxis may improve outcomes and minimize complications.
- Early detection and management of VUR are essential to prevent recurrent UTIs and subsequent renal scarring.
Objective:
Children with urinary tract infections (UTI) are at risk of renal scarring which may lead to impaired renal function and hypertension. This study examines the risk factors that predispose to recurrent UTI in children and the role of recurrent UTI in renal scarring.
Methodology:
A group of 290 children under 5 years of age with a first symptomatic UTI were studied. Micturating cystourethrogram and dimercaptosuccinic acid (DMSA) renal scintigraphy were performed at entry, and DMSA was repeated 1 year later. Two hundred and sixty-one children (90%) were followed up at 1 year.
Results:
There were 46 confirmed recurrent infections in 34 children, a recurrence rate of 12%. Multiple recurrence occurred in 14/34 (34%) children. Age of less than 6 months on entry independently predicted for recurrent UTI (odds ratio (OR): 2.9)). Compliance with prophylactic antibiotics fell throughout the year of follow up. Vesicoureteric reflux (VUR) was present in 14/34 (34%) of the group with recurrent UTI, 69/256 (27%) without recurrence. Urinary tract infection was significantly associated with bilateral and intrarenal reflux; grade 3-5 reflux independently predicted for recurrent UTI (OR: 3.5). Recurrent UTI was significantly associated with high grade DMSA defects on entry, renal parenchymal defects at 1 year follow up, and new defects at 1 year.
Conclusion:
The independent risk factors for recurrent UTI identified by this study were an age of less than 6 months at the index UTI and grade 3-5 VUR. These findings suggest more selective targeting may minimize problems associated with prophylaxis and improve outcomes for children with urine infection.