Risk factors for recurrent urinary tract infection and renal scarring

Ron Keren, Nader Shaikh, Hans Pohl, Lisa Gravens-Mueller, Anastasia Ivanova, Lisa Zaoutis, Melissa Patel, Rachel De Berardinis, Allison Parker, Sonika Bhatnagar, Mary Ann Haralam, Marcia Pope, Diana Kearney, Bruce Sprague, Raquel Barrera, Bernarda Viteri, Martina Egigueron, Neha Shah, Alejandro Hoberman

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis. METHODS: This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring. RESULTS: Children with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09-3.93]) and presence of renal scarring on the baseline 99mTc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22-6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86-4.87]). CONCLUSIONS: VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD.

Original languageEnglish (US)
Pages (from-to)e13-e21
JournalPediatrics
Volume136
Issue number1
DOIs
StatePublished - Jul 1 2015

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Vesico-Ureteral Reflux
Urinary Tract Infections
Cicatrix
Kidney
Urinary Bladder
Fever
Confidence Intervals
Technetium Tc 99m Dimercaptosuccinic Acid
Kaplan-Meier Estimate
Cohort Studies
Odds Ratio
Placebos
Prospective Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Keren, R., Shaikh, N., Pohl, H., Gravens-Mueller, L., Ivanova, A., Zaoutis, L., ... Hoberman, A. (2015). Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics, 136(1), e13-e21. https://doi.org/10.1542/peds.2015-0409

Risk factors for recurrent urinary tract infection and renal scarring. / Keren, Ron; Shaikh, Nader; Pohl, Hans; Gravens-Mueller, Lisa; Ivanova, Anastasia; Zaoutis, Lisa; Patel, Melissa; De Berardinis, Rachel; Parker, Allison; Bhatnagar, Sonika; Haralam, Mary Ann; Pope, Marcia; Kearney, Diana; Sprague, Bruce; Barrera, Raquel; Viteri, Bernarda; Egigueron, Martina; Shah, Neha; Hoberman, Alejandro.

In: Pediatrics, Vol. 136, No. 1, 01.07.2015, p. e13-e21.

Research output: Contribution to journalArticle

Keren, R, Shaikh, N, Pohl, H, Gravens-Mueller, L, Ivanova, A, Zaoutis, L, Patel, M, De Berardinis, R, Parker, A, Bhatnagar, S, Haralam, MA, Pope, M, Kearney, D, Sprague, B, Barrera, R, Viteri, B, Egigueron, M, Shah, N & Hoberman, A 2015, 'Risk factors for recurrent urinary tract infection and renal scarring', Pediatrics, vol. 136, no. 1, pp. e13-e21. https://doi.org/10.1542/peds.2015-0409
Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L et al. Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics. 2015 Jul 1;136(1):e13-e21. https://doi.org/10.1542/peds.2015-0409
Keren, Ron ; Shaikh, Nader ; Pohl, Hans ; Gravens-Mueller, Lisa ; Ivanova, Anastasia ; Zaoutis, Lisa ; Patel, Melissa ; De Berardinis, Rachel ; Parker, Allison ; Bhatnagar, Sonika ; Haralam, Mary Ann ; Pope, Marcia ; Kearney, Diana ; Sprague, Bruce ; Barrera, Raquel ; Viteri, Bernarda ; Egigueron, Martina ; Shah, Neha ; Hoberman, Alejandro. / Risk factors for recurrent urinary tract infection and renal scarring. In: Pediatrics. 2015 ; Vol. 136, No. 1. pp. e13-e21.
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abstract = "OBJECTIVES: To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis. METHODS: This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring. RESULTS: Children with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4{\%} compared with 17.3{\%} for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95{\%} confidence interval (CI): 1.09-3.93]) and presence of renal scarring on the baseline 99mTc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95{\%} CI: 1.22-6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56{\%}). At the end of the 2-year follow-up period, 8 (5.6{\%}) children in the no VUR group and 24 (10.2{\%}) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95{\%} CI: 0.86-4.87]). CONCLUSIONS: VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD.",
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T1 - Risk factors for recurrent urinary tract infection and renal scarring

AU - Keren, Ron

AU - Shaikh, Nader

AU - Pohl, Hans

AU - Gravens-Mueller, Lisa

AU - Ivanova, Anastasia

AU - Zaoutis, Lisa

AU - Patel, Melissa

AU - De Berardinis, Rachel

AU - Parker, Allison

AU - Bhatnagar, Sonika

AU - Haralam, Mary Ann

AU - Pope, Marcia

AU - Kearney, Diana

AU - Sprague, Bruce

AU - Barrera, Raquel

AU - Viteri, Bernarda

AU - Egigueron, Martina

AU - Shah, Neha

AU - Hoberman, Alejandro

PY - 2015/7/1

Y1 - 2015/7/1

N2 - OBJECTIVES: To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis. METHODS: This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring. RESULTS: Children with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09-3.93]) and presence of renal scarring on the baseline 99mTc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22-6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86-4.87]). CONCLUSIONS: VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD.

AB - OBJECTIVES: To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis. METHODS: This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring. RESULTS: Children with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09-3.93]) and presence of renal scarring on the baseline 99mTc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22-6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86-4.87]). CONCLUSIONS: VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD.

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