Prevention of recurrent febrile urinary tract infection in infants: Ultrasonography‐oriented approach is more practical than a top‐down approach

Abstract

Background: We previously reported that the top-down approach (TDA) for infants with febrile urinary tract infections (fUTI) could prevent recurrent fUTI (r-fUTI) but produced a high number of false-positives on acute-phase 99m Tc dimercaptosuccinic acid (DMSA) renal scintigraphy. Therefore we compared the ultrasonography-oriented approach (USOA) with TDA from the viewpoint of prevention of r-fUTI. Methods: The TDA was applied between July 2010 and February 2014 and the USOA was applied between March 2014 and April 2017 in infants with first fUTI. In the USOA group, voiding cystourethrography (VCUG) was performed in the case of abnormality on acute-phase renal bladder ultrasonography (RBUS) or on chronic-phase DMSA, which were performed in all cases. The frequency of r-fUTI was compared between the TDA group and USOA group retrospectively. Results: Seventy-four infants (52 male) and 79 infants (60 male) received TDA or USOA, respectively. No significant differences were found between the TDA and USOA groups in male : female ratio, age in months at initial onset of fUTI, observation period, or number of cases of r-fUTI (TDA group, n = 4; USOA group, n = 5). Seventy-four DMSA scintigraphy and 25 VCUG were carried out in the USOA group, and 111 DMSA scintigraphy and 34 VCUG in the TDA group. Conclusions: Both USOA and TDA were valid for prevention of r-fUTI, but USOA was superior to TDA with regard to the reduced number of patients undergoing VCUG and DMSA.

Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children

“…Of the 29 included studies, 9 studies were published between 2000 and 2010, whereas 20 studies were published between 2011 and 2022 (Table). Nineteen studies were retrospective, and 10 studies were prospective cohorts.…”

“…Of the 29 included studies, 9 studies were published between 2000 and 2010, whereas 20 studies were published between 2011 and 2022 (Table). Nineteen studies were retrospective, and 10 studies were prospective cohorts. No randomized clinical trials or cohort studies compared kidney ultrasonography with first febrile UTI vs targeted strategies (eg, deferring until second febrile UTI).…”

“…Twenty-four studies were conducted in children hospitalized for UTI, 1 in children exclusively in an ambulatory setting, and 3 in both settings . Fifteen studies only included children younger than 24 months. Of the 27 studies that reported sex, the median percentage of females was 40% (range, 20%-89%), and the median percentage of males was 60% (range, 11%-80%).…”

“…Of the 27 studies that reported sex, the median percentage of females was 40% (range, 20%-89%), and the median percentage of males was 60% (range, 11%-80%). Thirteen studies included pyuria in their UTI diagnostic criteria, and 23 studies defined abnormal ultrasonography results. The study sample size ranged from 66 to 820 children (median, 300 children).…”

“…The study sample size ranged from 66 to 820 children (median, 300 children). Of the 21 studies that reported the causative bacteria, Escherichia coli was the main causative bacteria (median, 86% [range, 67%-96%]). Fifteen of 25 studies that included data on kidney ultrasonography timing reported performing ultrasonography during the hospital admission or within a week after diagnosis of UTI.…”