Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux

Abstract

PurposeMany pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses.Materials and MethodsWe retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)].ResultsBreakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0±8.2 months) than in boys (5.8±4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean±SD age at diagnosis of VUR in patients with breakthrough infection (1.14±3.14) was significantly younger than in those without breakthrough infection (5.05±3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028).ConclusionOur data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.

Susceptibility of the Index Urinary Tract Infection to Prophylactic Antibiotics Is a Predictive Factor of Breakthrough Urinary Tract Infection in Children with Primary Vesicoureteral Reflux Receiving Continuous Antibiotic Prophylaxis

“…In this study, we also found that initial renal scarring is a significant predictor of breakthrough UTI in children with VUR receiving CAP. These findings are similar to those of previous studies 181920. Renal scarring has been accepted as a predictive factor for breakthrough infection in children with primary VUR 181920.…”

“…These findings are similar to those of previous studies 181920. Renal scarring has been accepted as a predictive factor for breakthrough infection in children with primary VUR 181920. Nakamura et al18 and Shiraishi et al19 showed that an abnormal renal scan as detected using DMSA is a prominent risk factor for breakthrough infection in patients with primary VUR who were treated with antibiotic prophylaxis.…”

Epidemiological urinalysis of children from kindergartens of Can Gio, Ho Chi Minh City - Vietnam

“…Searching for other modifiable host factors, such as voiding dysfunction or constipation, is crucial following the documentation of a UTI [ 25 , 26 ]. Hence, the appearance of any symptoms suggestive of a UTI in children should lead to a complete assessment, especially because vesicoureteral reflux is proved to be associated with recurrent infections [ 27 , 28 ]. Of course, vesicoureteral reflux is only interesting as a cause of UTIs in the youngest children or in those with recurrent pyelonephritis.…”

Neutrophil-to-lymphocyte ratio as a predictor of primary vesicoureteral reflux evolution in children with associated acute pyelonephritis

“…It is one of the most common urological disease in childhood, with an estimated prevalence of 0.4–1.8% in the general pediatric population and up to 30% in children with a history of urinary tract infection (UTI) ( 2 , 3 ). In these patients, VUR plays an important role in the pathogenesis of UTIs as the relationship between acute pyelonephritis (APN), VUR and renal damage is well established ( 4 ). VUR increases the risk of APN when lower UTIs are present, with a higher rate of febrile infection in the affected population and an increased risk of upper urinary tract damage and renal scarring ( 5 ).…”

“…Febrile UTI development has also shown a decreased likelihood of SR of primary VUR in children, although the role of APN and the systemic inflammatory response on the clinical course of VUR is still poorly understood. Furthermore, research on this topic is scarce, as most published studies only describe risk factors for the development of APN in patients with VUR ( 4 ).…”