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Predicting factors of breakthrough infection in children with primary vesicoureteral reflux
Hyeon Chan Jang1, Yoo Jun Park, Jae Shin Park
1Department of Urology, Catholic University of Daegu, School of Medicine, Daegu, Korea.
Insights
Children with abnormal renal scans, especially those under one year old, face a higher risk of breakthrough urinary tract infections despite antibiotic prophylaxis for vesicoureteral reflux (VUR). This highlights the need for vigilant monitoring to prevent potential kidney damage.
Area of Science:
- Pediatric Urology
- Infectious Diseases
- Nephrology
Background:
- Prophylactic antibiotics are commonly used for pediatric vesicoureteral reflux (VUR) to prevent urinary tract infections (UTIs).
- Breakthrough infections can occur, leading to renal scarring and increased morbidity.
- Identifying predictive factors for breakthrough infections is crucial for risk stratification and management.
Purpose of the Study:
- To determine if abnormal renal scans and other clinical factors predict breakthrough infections in children with VUR.
- To analyze prognostic factors associated with breakthrough UTIs in this pediatric population.
Main Methods:
- Retrospective review of 163 children diagnosed with VUR between 1997 and 2010.
- Analysis of clinical parameters including VUR grade, laterality, age, gender, and abnormal renal scans (using Dimercapto-succinic acid).
- Univariate analyses, Fisher's exact test, and unpaired t-test were employed to identify predictive factors.
Main Results:
- Breakthrough infections occurred in 48.0% of children; 45.7% had abnormal renal scans.
- Abnormal renal scans were the most predictive factor for breakthrough infection (p=0.062), particularly in children under one year old.
- Younger age at VUR diagnosis (p=0.009) and bilateral reflux (p=0.028) were significantly associated with breakthrough infections.
Conclusions:
- Abnormal renal scans are a significant predictor of breakthrough UTIs in children with VUR, especially those under one year of age.
- Children with abnormal renal scans and VUR, particularly infants, are at high risk for breakthrough infections.
- Increased awareness and monitoring are essential for these high-risk patients to prevent renal damage.
Purpose:
Many pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses.
Materials And Methods:
We retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)].
Results:
Breakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0±8.2 months) than in boys (5.8±4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean±SD age at diagnosis of VUR in patients with breakthrough infection (1.14±3.14) was significantly younger than in those without breakthrough infection (5.05±3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028).
Conclusion:
Our data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.
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