Predicting Breakthrough Urinary Tract Infection: Comparative Analysis of Vesicoureteral Reflux Index, Reflux Grade and Ureteral Diameter Ratio

Arlen, Angela M.; Leong, Traci; Wu, Charlotte Q.; Traore, Elizabeth J.; Cooper, Christopher S.; Kirsch, Andrew J.

doi:10.1097/ju.0000000000001035

Cited by 11 publications

(11 citation statements)

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“…To date, studies on paediatric UTIs have investigated association between a wide variety of risk factors in children or infants of varying ages with many different outcomes, such as kidney scarring, VUR and UTI recurrence. [15][16][17] We hypothesised that there is a set of risk factors in infants ≤3 months old who present with first febrile UTI which is associated with abnormal kidney imaging (US KUB, DMSA scan and/or MCU) and/or recurrent UTI. This is a pilot study from which results will be used to develop a prediction model or risk scoring system in a subsequent study with a larger group of patients.…”

Section: What This Study Addsmentioning

confidence: 99%

Risk factors for imaging abnormalities after the first febrile urinary tract infection in infants ≤3 months old: a retrospective cohort study

Chong

Leow

Yap

et al. 2023

bmjpo

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ObjectivesTo assess the association of clinical factors and investigation results (blood and urine) with imaging abnormalities (ultrasound of the kidneys, ureters and bladder; dimercaptosuccinic acid scan; and/or micturating cystourethrogram) and recurrent urinary tract infections (UTIs) in infants ≤3 months old presenting with their first febrile UTI.MethodsWe conducted a retrospective cohort study of infants ≤3 months old with first febrile UTI admitted from 2010 to 2016. Multivariable logistic regression model was used to analyse the association of imaging abnormalities and recurrent UTI with covariates selected a priori: age at presentation, maximum temperature, duration of illness at presentation, interval between start of antibiotics and fever resolution, C-reactive protein, total white cell count on the full blood count, bacteraemia, white cell count on the urinalysis and non-Escherichia coligrowth in the urine culture (non-E. coliUTI).ResultsThere were 190 infants but 12 did not undergo any imaging. Median age at presentation was 63 days (IQR 41–78). Twenty-four patients had imaging abnormalities. Non-E. coliUTI (adjusted OR (aOR) 5.01, 95% CI 1.65 to 15.24, p=0.004) was independently associated with imaging abnormalities, while bacteraemia (aOR 4.93, 95% CI 1.25 to 19.43, p=0.022) and non-E. coliUTI (aOR 5.06, 95% CI 1.90 to 13.48, p=0.001) were independently associated with recurrent UTI.ConclusionNon-E. coliUTI at the first febrile UTI in infants ≤3 months old may be useful in predicting imaging abnormalities while bacteraemia and non-E. coliUTI may be useful to predict recurrent UTI.

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Section: What This Study Addsmentioning

confidence: 99%

Risk factors for imaging abnormalities after the first febrile urinary tract infection in infants ≤3 months old: a retrospective cohort study

Chong

Leow

Yap

et al. 2023

bmjpo

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“…Reliability of this index was initially shown in a cohort of VUR patients aged <2 years (n = 229), and then validated in a second cohort of patients aged <2 years (n = 369) as well as in 271 patients aged >2 years (23, 61,62). The VUR index score has also been shown to correlate with the risk of developing UTIs (Figure 1) (23, 62,63). Importantly, both UDR and VUR index appear superior to international VUR grading in predicting either spontaneous resolution of VUR or risk of a breakthrough UTI in children aged <2 years at diagnosis (55,61,63).…”

Section: Diagnosis and Assessmentmentioning

confidence: 97%

“…The VUR index score has also been shown to correlate with the risk of developing UTIs (Figure 1) (23, 62,63). Importantly, both UDR and VUR index appear superior to international VUR grading in predicting either spontaneous resolution of VUR or risk of a breakthrough UTI in children aged <2 years at diagnosis (55,61,63). Contrast-enhanced voiding urosonography (ceVUS) could potentially be used as a replacement for VCUG.…”

Section: Diagnosis and Assessmentmentioning

confidence: 99%

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

et al. 2021

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Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection, renal scarring and reflux nephropathy. We review advancements over the last two decades in our understanding and management of VUR. Over time, the condition may resolve spontaneously but it can persist for many years and bladder/bowel dysfunction is often involved. Some factors that increase the likelihood of persistence (e.g., high grade) also increase the risk of renal scarring. Voiding cystourethrography (VCUG) is generally considered the definitive method for diagnosing VUR, and helpful in determining the need for treatment. However, this procedure causes distress and radiation exposure. Therefore, strategies to reduce clinicians' reliance upon VCUG (e.g., after a VUR treatment procedure) have been developed. There are several options for managing patients with VUR. Observation is suitable only for patients at low risk of renal injury. Antibiotic prophylaxis can reduce the incidence of UTIs, but drawbacks such as antibiotic resistance and incomplete adherence mean that this option is not viable for long-term use. Long-term studies of endoscopic injection have helped us understand factors influencing use and the effectiveness of this procedure. Ureteral reimplantation is still performed commonly, and robot-assisted laparoscopic methods are gaining popularity. Over the last 20 years, there has been a shift toward more conservative management of VUR with an individualized, risk-based approach. For continued treatment improvement, better identification of children at risk of renal scarring, robust evidence regarding the available interventions, and an improved VUR grading system are needed.

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“…In a multicenter study Arlen et al (page 572) report use of a vesicoureteral reflux index as a way to predict the risk of breakthrough infection. 3 As breakthrough infection is a common reason for switching from observation with or without antibiotic prophylaxis to surgical treatment, improved ability to predict infection may improve the ability to predict need for surgical treatment. This would clearly be helpful for clinicians, patients and families.…”

Section: Predicting Breakthrough Urinary Tract Infectionmentioning

confidence: 99%

This Month in Pediatric Urology

Wan¹

2020

Journal of Urology

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In 2006 the Spina Bifida Association conducted a survey that identified differences in how care and services are delivered. To address these gaps, the association's Professional Advisory Council recommended creation of a national database to collect the data needed to make meaningful improvements in care. Established in 2008, the National Spina Bifida Patient Registry is managed and funded by the Centers for Disease Control and Prevention.

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Predicting Breakthrough Urinary Tract Infection: Comparative Analysis of Vesicoureteral Reflux Index, Reflux Grade and Ureteral Diameter Ratio

Cited by 11 publications

References 0 publications

Risk factors for imaging abnormalities after the first febrile urinary tract infection in infants ≤3 months old: a retrospective cohort study

Risk factors for imaging abnormalities after the first febrile urinary tract infection in infants ≤3 months old: a retrospective cohort study

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

This Month in Pediatric Urology

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