First urinary tract infections in children: the role of the risk factors proposed by the Italian recommendations. (17th August 2018)

• Record Type: Journal Article
• Authors: Alberici, I; La Manna, A; Pennesi, M; Starc, M; Scozzola, F; Nicolini, G; Toffolo, A; Marra, G; Chimenz, R; Sica, F; Maringhini, S; Monasta, L; Montini, G
• Is Part Of: Acta pædiatrica. Volume 108:Number 3(2019)
• Page Start: 544
• Page End: 550
• Publication Date: 2018-08-17
• Subjects: Guidelines -- Urinary tract infection -- Vesicoureteral reflux; Pediatrics -- Periodicals; Pediatrics; 618.92
• DOI: 10.1111/apa.14506
• Languages: English
• ISSNs: 0803-5253

Abstract

Abstract: Aim: In 2009, the Italian society for paediatric nephrology suggested the need for cystography, following a first febrile urinary tract infection (UTI), only in children at high risk for dilating vesicoureteral reflux or in the event of a second infection. The aim of this study was to evaluate the adequacy of the risk factors proposed by the Italian guidelines. Methods: Children aged 2–36 months, managed by 10 Italian hospitals between 2009 and 2013, with a first febrile UTI were retrospectively evaluated. Results: Four hundred and fourteen children were included: 51% female, mean age eight months. Escherichia coli was responsible of 84% UTIs. 269 children (65%) presented at least one risk factor, thus were further investigated: 44% had a reflux. The presence of a pathogen other than E. coli significantly predicted high‐grade reflux, both in the univariate (Odd Ratio 2.52, 95% Confidence Interval 1.32–4.81, p < 0.005) and multivariate analysis (OR 2.74, 95% CI: 1.39–5.41, p: 0.003). 26/145 children (18%) with no risk factors experienced a second UTI, which prompted the execution of cystography, showing a dilating reflux in 11. Conclusion: Among the risk factors proposed by the Italian guidelines, only the presence of a pathogen other than E. coli significantly predicted reflux. Cystography can be postponed in children with no risk factors.