Long-term Follow-up of Patients After Childhood Urinary Tract Infection

Hannula, Annukka; Perhomaa, Marja; Venhola, Mika; Pokka, Tytti; Renko, Marjo; Uhari, Matti

doi:10.1001/archpediatrics.2012.1383

Cited by 28 publications

(15 citation statements)

References 28 publications

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“…This more restrictive approach to imaging is also in accordance with the recent guidelines developed by the AAP (19). In addition, none of these children developed hypertension during their follow-up period, which is consistent with the work by Hannula et al on the long-term impact of pediatric urinary tract infections (20). …”

Section: Discussionsupporting

confidence: 90%

Discontinuation of Antimicrobial Prophylaxis (AP) in Children With Spina Bifida: A Case Series Analysis

et al. 2016

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BackgroundSpina bifida increases the risk for urinary tract infections (UTI). Antimicrobial prophylaxis (AP) reduces symptomatic UTI’s but selects resistant organisms. Measures to ensure regular and complete emptying of the bladder combined with treatment of constipation reduce the risk for UTI.ObjectivesDemonstrate that close adherence to a catheterization regimen in children with spina bifida (Selective Treatment - ST) reduces the need for antimicrobial prophylaxis.MethodsCase series analysis of pediatric spina bifida clinic patients where routine antimicrobial prophylaxis was replaced by clean-catch catheterization and daily bowel regimen (ST). Retrospective chart review of 67 children (mean entry age: 24 months, median age: 4 months; 32 Males, 35 Females) enrolled between 1986 - 2004. Mean follow-up was 128.6 months (range 3 - 257 months). Asymptomatic and symptomatic UTI incidences were noted on AP and ST protocols. Creatinine clearance at study entry and follow-up was calculated by the age appropriate method. A multivariable regression model with delta Glomerular Filtration Rate (GFR) as the dependent variable, independent sample t-test and Wilcoxon rank sum were performed with SAS v. 9.2.ResultsThe mean number of infections while on AP was 8.7 (95% CI 5.72, 11.68) and was 1.0 on ST (95% CI 0.48, 1.43). 5 infections on the AP protocol required intravenous (IV) antibiotics due to resistance to oral therapy, but none on ST. Comparing change in GFR between both protocols (AP vs. ST) found a significant difference in the change of GFR by treatment protocol.ConclusionsAP did not prevent UTIs and resulted in more resistant organisms requiring IV antibiotics. Discontinuing AP allowed the return of susceptibility to oral antimicrobials and significantly improved GFR in those children who had previously been on AP. Adherence to a catheterization regimen with prompt treatment of symptomatic UTI conserved renal function and prevented selection of resistant organisms.

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Section: Discussionsupporting

confidence: 90%

Discontinuation of Antimicrobial Prophylaxis (AP) in Children With Spina Bifida: A Case Series Analysis

et al. 2016

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“…Moreover, we found no difference in cases showing impaired renal function or proteinuria at follow-up. Previous studies regarding the long-term outcomes www.nature.com/scientificreports www.nature.com/scientificreports/ for children with UTI showed no significant decline in renal function after childhood UTI 39,43 . However, other long-term studies have shown that the onset of complications after UTI (e.g.…”

Section: Discussionmentioning

confidence: 94%

Predictive factors for bacteremia in febrile infants with urinary tract infection

Yoon

Shin

Lee

et al. 2020

Sci Rep

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this study aimed to investigate the predictive factors of concomitant bacteremia occurring in febrile infants who initially presented with pyuria and fever, and were subsequently diagnosed with cultureproven urinary tract infection (UTI). We conducted a retrospective cohort study for January 2010-October 2018 that included infants younger than six months with febrile UTI at a tertiary hospital. The study included 463 patients, of whom 34 had a concomitant bacteremic UTI. Compared to those in the non-bacteremic urinary tract infection (Uti) group, the bacteremic Uti group had a lower mean age; higher levels of C-reactive protein (CRP), delta neutrophil index (DNI, reflects the fraction of immature granulocytes) and blood urea nitrogen (BUn); lower levels of hemoglobin (Hb) and albumin; and a lower platelet count. Vesicoureteral reflux (VUR) was detected nearly twice as often in patients with bacteremic UTI compared to those with non-bacteremic UTI (59.3% vs. 30.6%; P = 0.003). Univariate logistic analyses showed that age ≤90 days; higher DNI, CRP, and creatinine levels; lower Hb and albumin levels; and the presence of VUR were predictors for bacteremic Uti. on multivariate logistic regression analysis, age ≤90 days, higher DNI and CRP levels, and the presence of VUR were independent predictors of bacteremic Uti. the area under the receiver operating characteristic curve of the multivariate model was 0.859 (95% CI, 0.779-0.939; P < 0.001). Age ≤90 days, higher DNI and CRP values may help predict bacteremia of febrile infants younger than 6 months with UTI. Vesicoureteral reflux imaging is also recommended in infants with bacteremic UTI to evaluate VUR.Urinary tract infection (UTI) has been described as the most common serious bacterial infection in febrile infants 1 . The rate of concomitant bacteremia in febrile UTI varies from 5% to 31%, depending on various locations and patient cohorts 2,3 . Although a recent study has shown that outcomes were good among infants with bacteremic UTI 4 , infants with concomitant bacteremic UTI are still prone to adverse outcomes such as prolonged admission, shock, bacterial meningitis, and intensive-care unit admission 5 . Early diagnosis and prompt decision-making on the initial treatment of young febrile infants suspected of having bacteremia are important but not feasible because confirming positive blood cultures is usually time-consuming.Several factors have been previously reported to predict bacteremic UTI in pediatric patients: younger age 3,6 ; clinical presentation such as ill appearance 5,7 and feeding problems 8 ; laboratory parameters including increased creatinine levels 9,10 ; high levels of inflammatory markers such as white blood cell (WBC) count 5 , presence of bands 5 and C-reactive protein (CRP) 7,10,11 ; and genitourinary (GU) tract malformations 8 .However, the clinical signs or symptoms of UTI are usually vague and unspecific in young infants 12 . Clinically determining whether children have serious complications when they may not appear ill is difficult fo...

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“…However, this study and others have previously shown that UTIs were only associated with dilating VUR. It is important to limit VCUGs to patients with a high risk of grade 4-5 VUR, as VCUGs are known to predispose patients to UTIs, expose children to unnecessary radiation and cause discomfort due to catheterisation (6,7,10,24). According to our recent study, grade 4-5 was not associated with the degree of HN and it was reduced renal length and visible ureter that predicted VUR (16).…”

Section: Discussionmentioning

confidence: 91%

Reduced differential renal function in scintigraphy predicted high‐grade vesicoureteral reflux in children with antenatal hydronephrosiss

et al. 2018

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Long-term Follow-up of Patients After Childhood Urinary Tract Infection

Cited by 28 publications

References 28 publications

Discontinuation of Antimicrobial Prophylaxis (AP) in Children With Spina Bifida: A Case Series Analysis

Discontinuation of Antimicrobial Prophylaxis (AP) in Children With Spina Bifida: A Case Series Analysis

Predictive factors for bacteremia in febrile infants with urinary tract infection

Reduced differential renal function in scintigraphy predicted high‐grade vesicoureteral reflux in children with antenatal hydronephrosiss

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