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Optimizing risk stratification in pediatric febrile urinary tract infection: A single-center study in Japan
Tomohiro Inoguchi1,2, Riku Hamada1,2, Yooka Nam1
1Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Insights
Identifying non-Escherichia coli infections and abnormal kidney-bladder ultrasounds can predict the need for interventions in East Asian children with febrile urinary tract infections (f-UTI). This helps in better risk stratification and targeted imaging.
Area of Science:
- Pediatrics
- Infectious Diseases
- Urology
Background:
- Febrile urinary tract infections (f-UTI) in children can lead to kidney scarring, necessitating effective risk stratification for timely intervention.
- Current guidelines for imaging in f-UTI are primarily based on Western populations and may not accurately predict intervention needs in East Asian children.
- Predicting which children require therapeutic interventions is crucial for preventing long-term complications.
Purpose of the Study:
- To establish risk stratification criteria for East Asian children experiencing their first episode of f-UTI.
- To identify specific predictors for the requirement of therapeutic interventions in this pediatric population.
- To enhance clinical decision-making regarding imaging and management of f-UTI in East Asian children.
Main Methods:
- A retrospective single-center study analyzed 216 children aged 2-24 months with first-episode f-UTI.
- Patients underwent standardized kidney-bladder ultrasound (KBUS) and voiding cystourethrography (VCUG).
- Multivariate logistic regression identified independent predictors for the primary outcome: requirement for therapeutic intervention (urological surgery, antimicrobial prophylaxis, or treatment for recurrent f-UTI).
Main Results:
- Fifty-nine out of 216 patients required therapeutic interventions.
- Non-Escherichia coli infection (OR 3.3) and abnormal KBUS findings (OR 5.3) were identified as independent predictors of requiring intervention.
- The identified predictors demonstrated a sensitivity of 64.4% and specificity of 73.2% for predicting the need for therapeutic intervention.
Conclusions:
- Non-E. coli infection and abnormal KBUS findings are significant predictors for requiring therapeutic interventions in East Asian children with first-episode f-UTI.
- These predictors can aid in optimizing risk stratification and patient selection for VCUG, improving diagnostic accuracy.
- A targeted approach using these factors can lead to more efficient and effective management of f-UTI in this demographic.
Abstract:
Selecting optimal therapeutic interventions for febrile urinary tract infection (f-UTI) is crucial to prevent complications such as kidney scarring. While current clinical guidelines provide risk-stratified imaging recommendations, they are largely based on Western populations and lack specific predictors for which children will ultimately require therapeutic interventions. This study aimed to establish risk stratification criteria for East Asian children with first-episode f-UTI. This retrospective single-center study analyzed patients aged 2-24 months with first-episode f-UTI. All patients underwent a standardized diagnostic and management protocol, including kidney-bladder ultrasound (KBUS) and voiding cystourethrography (VCUG), to ensure uniform evaluation. The primary outcome was "requirement for therapeutic intervention," defined as one or more of the following: (1) urological surgery (2) antimicrobial prophylaxis (for vesicoureteral reflux grade ≥III) and (3) antimicrobial treatment for recurrent f-UTI. Multivariate logistic regression was performed to identify independent predictors associated with the interventions. A total of 216 patients were included (median age: 4 months). Overall, 59 patients required therapeutic interventions. Non-Escherichia coli infection (OR 3.3, 95% CI 1.3-8.7) and abnormal KBUS findings (OR 5.3, 95% CI 2.7-10.6) were identified as independent predictors. The sensitivity and specificity of the factors for predicting therapeutic intervention were 64.4% and 73.2%, respectively. This study identified non-E. coli infection and abnormal KBUS findings as key predictors for therapeutic interventions in East Asian children with first-episode f-UTI. These findings suggest that a more targeted approach based on these factors may optimize risk stratification and patient selection for VCUG, improving clinical decision-making.
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