Related Experiment Video
Updated: May 6, 2026
Establishment and Characterization of UTI and CAUTI in a Mouse Model
Published on: June 23, 2015
Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials
Patrick H Conway1, Avital Cnaan, Theoklis Zaoutis
1Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA 19104, USA. pconway2@mail.med.upenn.edu
Insights
Antimicrobial prophylaxis did not reduce recurrent urinary tract infections (UTIs) in children. However, it increased the risk of antibiotic resistance in recurrent UTIs, highlighting a critical concern for pediatric care.
Area of Science:
- Pediatric infectious diseases
- Clinical epidemiology
- Antimicrobial stewardship
Background:
- Limited evidence exists on urinary tract infection (UTI) risk factors and antimicrobial prophylaxis effectiveness in children.
- Recurrent UTIs pose a significant challenge in pediatric primary care.
Purpose of the Study:
- Identify risk factors for recurrent UTIs in children aged 6 years or younger.
- Determine the association between antimicrobial prophylaxis and recurrent UTIs.
- Identify risk factors for antimicrobial resistance in recurrent UTIs.
Main Methods:
- A cohort study of 611 children with first UTI from 27 pediatric practices.
- Time-to-event analysis to assess risk factors and prophylaxis association.
- Nested case-control study to identify resistance risk factors.
Main Results:
- White race, ages 3-5 years, and grade 4-5 vesicoureteral reflux were associated with increased recurrent UTI risk.
- Antimicrobial prophylaxis showed no significant association with decreased recurrent UTI risk.
- Antimicrobial prophylaxis was a significant risk factor for antimicrobial resistance in recurrent UTIs.
Conclusions:
- Antimicrobial prophylaxis is not associated with a reduced risk of recurrent UTIs in children.
- Prophylaxis use is linked to an increased risk of developing resistant infections in pediatric UTIs.
Context:
The evidence regarding risk factors for recurrent urinary tract infection (UTI) and the risks and benefits of antimicrobial prophylaxis in children is scant.
Objectives:
To identify risk factors for recurrent UTI in a pediatric primary care cohort, to determine the association between antimicrobial prophylaxis and recurrent UTI, and to identify the risk factors for resistance among recurrent UTIs.
Design, Patients, And Setting:
From a network of 27 primary care pediatric practices in urban, suburban, and semirural areas spanning 3 states, a cohort of children aged 6 years or younger who were diagnosed with first UTI between July 1, 2001, and May 31, 2006, was assembled. Time-to-event analysis was used to determine risk factors for recurrent UTI and the association between antimicrobial prophylaxis and recurrent UTI, and a nested case-control study was performed among children with recurrent UTI to identify risk factors for resistant infections.
Main Outcome Measures:
Time to recurrent UTI and antimicrobial resistance of recurrent UTI pathogens.
Results:
Among 74 974 children in the network, 611 (0.007 per person-year) had a first UTI and 83 (0.12 per person-year after first UTI) had a recurrent UTI. In multivariable Cox time-to-event models, factors associated with increased risk of recurrent UTI included white race (0.17 per person-year; hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.22-3.16), age 3 to 4 years (0.22 per person-year; HR, 2.75; 95% CI, 1.37-5.51), age 4 to 5 years (0.19 per person-year; HR, 2.47; 95% CI, 1.19-5.12), and grade 4 to 5 vesicoureteral reflux (0.60 per person-year; HR, 4.38; 95% CI, 1.26-15.29). Sex and grade 1 to 3 vesicoureteral reflux were not associated with risk of recurrence. Antimicrobial prophylaxis was not associated with decreased risk of recurrent UTI (HR, 1.01; 95% CI, 0.50-2.02), even after adjusting for propensity to receive prophylaxis, but was a risk factor for antibimicrobial resistance among children with recurrent UTI (HR, 7.50; 95% CI, 1.60-35.17).
Conclusion:
Among the children in this study, antimicrobial prophylaxis was not associated with decreased risk of recurrent UTI, but was associated with increased risk of resistant infections.
Related Concept Videos
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:17Urinary Tract Infection IV: Nursing Management
01:27Acute Pyelonephritis I: Introduction
01:28Microbiota of the Urogenital Tract