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Risk factors for imaging abnormalities after the first febrile urinary tract infection in infants ≤3 months old: a
Siew Lew Chong1, Esther Huimin Leow2, Celeste Jia Ying Yap1
1Paediatric Nephrology, KK Women's and Children's Hospital, Singapore.
Insights
Non-Escherichia coli urinary tract infections (UTIs) in infants under 3 months may predict imaging abnormalities. These infections, along with bacteremia, also predict recurrent UTIs in this age group.
Area of Science:
- Pediatrics
- Infectious Diseases
- Medical Imaging
Background:
- Febrile urinary tract infections (UTIs) in infants under 3 months require careful evaluation.
- Identifying predictors for imaging abnormalities and recurrent UTIs is crucial for timely intervention.
Purpose of the Study:
- To determine the association of clinical factors and laboratory results with imaging abnormalities.
- To identify predictors for recurrent UTIs in infants presenting with their first febrile UTI.
Main Methods:
- Retrospective cohort study of infants ≤3 months with first febrile UTI (2010-2016).
- Multivariable logistic regression analyzed associations with imaging abnormalities and recurrent UTIs.
- Covariates included age, temperature, illness duration, antibiotic response, CRP, WBC, bacteremia, and urinalysis findings.
Main Results:
- Non-Escherichia coli UTI was independently associated with imaging abnormalities (aOR 5.01).
- Bacteremia (aOR 4.93) and non-Escherichia coli UTI (aOR 5.06) were independently associated with recurrent UTIs.
Conclusions:
- Non-Escherichia coli UTI in infants ≤3 months may predict imaging abnormalities.
- Bacteremia and non-Escherichia coli UTI can help predict recurrent UTIs in this vulnerable population.
Objectives:
To assess the association of clinical factors and investigation results (blood and urine) with imaging abnormalities (ultrasound of the kidneys, ureters and bladder; dimercaptosuccinic acid scan; and/or micturating cystourethrogram) and recurrent urinary tract infections (UTIs) in infants ≤3 months old presenting with their first febrile UTI.
Methods:
We conducted a retrospective cohort study of infants ≤3 months old with first febrile UTI admitted from 2010 to 2016. Multivariable logistic regression model was used to analyse the association of imaging abnormalities and recurrent UTI with covariates selected a priori: age at presentation, maximum temperature, duration of illness at presentation, interval between start of antibiotics and fever resolution, C-reactive protein, total white cell count on the full blood count, bacteraemia, white cell count on the urinalysis and non-Escherichia coli growth in the urine culture (non-E. coli UTI).
Results:
There were 190 infants but 12 did not undergo any imaging. Median age at presentation was 63 days (IQR 41-78). Twenty-four patients had imaging abnormalities. Non-E. coli UTI (adjusted OR (aOR) 5.01, 95% CI 1.65 to 15.24, p=0.004) was independently associated with imaging abnormalities, while bacteraemia (aOR 4.93, 95% CI 1.25 to 19.43, p=0.022) and non-E. coli UTI (aOR 5.06, 95% CI 1.90 to 13.48, p=0.001) were independently associated with recurrent UTI.
Conclusion:
Non-E. coli UTI at the first febrile UTI in infants ≤3 months old may be useful in predicting imaging abnormalities while bacteraemia and non-E. coli UTI may be useful to predict recurrent UTI.
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