Elsevier

Urology

Volume 63, Issue 3, March 2004, Pages 562-565
Urology

Pediatric urology
Children with a febrile urinary tract infection and a negative radiologic workup: factors predictive of recurrence

https://doi.org/10.1016/j.urology.2003.10.055Get rights and content

Abstract

Objectives

To determine the recurrence rate and risk factors for urinary tract infection (UTI) in children who present with a febrile UTI and have a negative radiologic evaluation. Febrile UTIs with no urinary tract abnormalities are a common cause of morbidity in children.

Methods

We performed a retrospective review of all children referred to our medical center after a febrile UTI.

Results

We reviewed 850 charts. Of 850 children, 78 had had a febrile UTI and normal ultrasound and voiding cystourography findings. Of the 78 children, 25 had had a recurrent UTI (3 boys and 22 girls). Forty-five percent of the girls with a febrile UTI developed a recurrent UTI and 14% of the boys had a recurrent UTI (P = 0.02). Three boys (two younger than 1 year of age) were uncircumcised and had one recurrent febrile UTI. Eleven (39%) of 28 girls who first presented at younger than 1 year of age and 7 (58%) of 12 girls who presented at 5 years of age or older had recurrent UTIs. The recurrence rate in the 2 to 5-year-old age group was 24% (4 of 17). Seven of the older girls exhibited symptoms of dysfunctional elimination syndrome.

Conclusions

In children with a febrile UTI and a negative radiologic evaluation, recurrence was more common in girls. Boys who were uncircumcised may be at an increased risk of infection during the first year of life. In girls, the age at the time of the first infection was not predictive of recurrence. Although dysfunctional voiding and elimination may contribute to recurrent febrile UTIs in young children, an association seems to be present in children 5 years old and older.

Section snippets

Material and methods

A retrospective evaluation of children referred to our medical center (all services) for radiologic evaluation after a febrile UTI was performed. Renal/bladder ultrasonography and voiding cystourethrography were performed on all patients to rule out hydronephrosis and reflux, respectively. We reviewed the medical records for symptoms, method of specimen collection, type of organism, oral/intravenous antibiotic administration, toilet training, evidence of voiding/elimination dysfunction, and

Results

We reviewed the charts of 850 children who presented to our institution from 1993 to 2000 with a febrile UTI. Of the 850 children, 78 of these children had a febrile UTI and normal ultrasound and voiding cystourethrography findings (Table I). Of the 78 children, 21 were boys (mean age 21 months, range 1 to 168) and 57 were girls (mean age 31 months, range 1 to 120). Thirteen of the boys were younger than 1 year of age and seven were between 2 and 5 years of age. Twenty-eight girls were younger

Comment

Our study sought to determine the natural history and risk factors for recurrent UTIs in children with a normal anatomic workup. We observed that girls had a statistically significant risk of recurrent febrile UTI compared with boys, even those who were uncircumcised. We found that the age at the time of the first UTI was not predictive of recurrence. It also appeared that UTIs in girls aged 5 years and older were more often associated with dysfunctional elimination.

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Conclusions

Our results suggest that in children who present with a febrile UTI and have a normal radiologic evaluation, recurrence is more common in girls. However, uncircumcised boys are at a greater risk of infection during the first year of life. In the case of repeat UTI, these boys may benefit from treatment of phimosis. In girls, the age at the time of the first UTI was not predictive of recurrence. Recurrent UTI in children 5 years of age and older was associated with dysfunctional elimination.

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