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Risk factors for febrile urinary tract infection in boys with posterior urethral valves
Luke Harper1,2, Nathalie Botto3, Matthieu Peycelon4
1Department of Pediatric Surgery, CHU de La Réunion, Saint-Denis, France.
Insights
Boys with posterior urethral valves (PUV) have a higher risk of febrile urinary tract infections (fUTI). The presence of dilating vesicoureteral reflux (VUR) is a key risk factor for fUTI in these patients.
Area of Science:
- Pediatric Urology
- Infectious Diseases
- Nephrology
Background:
- Boys with posterior urethral valves (PUV) face an elevated risk of febrile urinary tract infections (fUTI).
- Identifying specific risk factors is crucial for developing targeted UTI prevention strategies.
- The CIRCUP randomized controlled trial provides valuable data for this investigation.
Purpose of the Study:
- To identify patient characteristics associated with an increased risk of fUTI in boys with PUV.
- To leverage data from the CIRCUP trial for secondary analysis.
- To inform tailored UTI prevention strategies for this vulnerable population.
Main Methods:
- Secondary analysis of the CIRCUP randomized trial data.
- Focus on boys with PUV receiving antibiotic prophylaxis alone.
- Comparison of patient characteristics (age at diagnosis, birth size, VUR grade, DMSA scan, creatinine) between those with and without fUTI.
Main Results:
- 17 out of 42 patients presented with at least one fUTI.
- The presence of dilating vesicoureteral reflux (VUR) was significantly associated with an increased risk of fUTI (OR: 6, p=0.03).
- No other analyzed parameters showed a significant association with fUTI risk. Infection rates decreased after 40 and 240 days of life.
Conclusions:
- In boys with PUV, high-grade VUR is a significant risk factor for developing fUTI.
- The incidence of fUTI appears to decline after approximately 9 months of age.
- These findings can guide more precise UTI prevention in boys with PUV and VUR.
Objective:
Boys with posterior urethral valves (PUV) present an increased risk of febrile urinary tract infection (fUTI). Identifying specific risk factors could allow for tailoring UTI prevention. The aim of this study was to use the data from the CIRCUP randomized controlled trial data to identify patient characteristics associated with a higher risk of fUTI.
Patients And Methods:
We performed a secondary analysis of the data from the CIRCUP randomized trial which included boys with PUV, randomized to circumcision and antibiotic prophylaxis vs. antibiotic prophylaxis alone and followed for 2 years. There was only 1 episode of fUTI in the circumcision group vs. 17 in the uncircumcised group. We therefore only studied the antibiotic prophylaxis alone group and compared age at prenatal diagnosis, size and weight at birth, presence of dilating VUR at diagnosis, abnormal DMSA scan at 2 months, and nadir creatinine between children who presented a fUTI and those who did not, as well as age at first episode of fUTI.
Results:
The study group consisted of 42 patients of which 17 presented at least on fUTI. Presence of dilating VUR was significantly associated with risk of fUTI (p = 0.03), OR: 6 [CI 95% = (1.13-27.52)]. None of the other parameters were associated with increased risk of fUTI. We observed three distinct time periods for presenting a fUTI with a decrease in infection rate after the first 40 days of life, then at 240 days of life.
Conclusion:
In boys with PUV, presence of high-grade VUR is associated with a higher risk of presenting a fUTI. The rate of febrile UTIs seems to decrease after 9 months.
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