Risk factors for recurrent urinary tract infections in young infants under the age of 24 months
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Purpose: Recurrent urinary tract infections (UTIs) in children is a major challenge for pediatricians. This study was designed to investigate the risk factors for recurrent UTIs and determine the association between recurrent UTIs and clinical findings, including growth patterns in infants and children younger than 24 months of age. Methods: We retrospectively reviewed the medical records of 147 patients <24 months of age with UTIs who were hospitalized between August 2018 and October 2021. The patients were divided into recurrent and single UTI episode groups. Clinical findings and anthropometric and laboratory data were compared between the two groups.Results:In the recurrent UTI group, the weight-for-length (WFL) percentile at the first UTI diagnosis was lower compared to the single UTI episode group, and the weight-for-age percentile at 3-month and 6-month follow-ups after the first UTI decreased (all P<0.05). In univariable logistic regression analysis, higher birth weight, lower WFL percentile, the presence of hydronephrosis, acute pyelonephritis or vesicoureteral reflux, the use of prophylactic antibiotics, and non-Escherichia coli infections were associated with the development of recurrent UTIs (all P<0.05). However, in the multivariable analysis, only the presence of hydronephrosis and prophylactic antibiotic use were independently related to UTI recurrence (P<0.05). Conclusion: The presence of hydronephrosis at the first UTI can be helpful for predicting UTI recurrence in young children aged < 24 months. Antibiotic prophylaxis may be associated with UTI recurrence. Potential growth delay should be carefully monitored in infants with recurrent UTI.
Abstract
Purpose: Recurrent urinary tract infections (UTIs) in children is a major challenge for pediatricians. This study was designed to investigate the risk factors for recurrent UTIs and determine the association between recurrent UTIs and clinical findings, including growth patterns in infants and children younger than 24 months of age. Methods: We retrospectively reviewed the medical records of 147 patients <24 months of age with UTIs who were hospitalized between August 2018 and October 2021. The patients were divided into recurrent and single UTI episode groups. Clinical findings and anthropometric and laboratory data were compared between the two groups.Results:In the recurrent UTI group, the weight-for-length (WFL) percentile at the first UTI diagnosis was lower compared to the single UTI episode group, and the weight-for-age percentile at 3-month and 6-month follow-ups after the first UTI decreased (all P<0.05). In univariable logistic regression analysis, higher birth weight, lower WFL percentile, the presence of hydronephrosis, acute pyelonephritis or vesicoureteral reflux, the use of prophylactic antibiotics, and non-Escherichia coli infections were associated with the development of recurrent UTIs (all P<0.05). However, in the multivariable analysis, only the presence of hydronephrosis and prophylactic antibiotic use were independently related to UTI recurrence (P<0.05). Conclusion: The presence of hydronephrosis at the first UTI can be helpful for predicting UTI recurrence in young children aged < 24 months. Antibiotic prophylaxis may be associated with UTI recurrence. Potential growth delay should be carefully monitored in infants with recurrent UTI.
참고문헌 (40)
- Hellstrom A, "Association between urinary symptoms at 7 years old and previous urinary tract infection", Arch Dis Child, 66, pp.232~234 (1991)
- Williams G, "Prevention of recurrent urinary tract infection in children", Curr Opin Infect Dis, 22, pp.72~76 (2009)
- Jodal U, "The natural history of bacteriuria in childhood", Infect Dis Clin North Am, 1, pp.713~730 (1987)
- Finnell SM, "Technical report: diagnosis and management of an initial UTI in febrile infants and young children", Pediatrics, 128, pp.e749~e770 (2011)
- Keren R, "Risk factors for recurrent urinary tract infection and renal scarring", Pediatrics, 136, pp.e13~21 (2015)
- Park S, "Risk factors for recurrent urinary tract infection in infants with vesicoureteral reflux during prophylactic treatment : effect of delayed contrast passage on voiding cystourethrogram", Urology, 78, pp.170~173 (2011)
- Elder JS, "Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children", J Urol, 157, pp.1846~1851 (1997)
- Panaretto K, "Risk factors for recurrent urinary tract infection in preschool children", J Paediatr Child Health, 35, pp.454~459 (1999)
- Craig JC, "Antibiotic prophylaxis and recurrent urinary tract infection in children", N Engl J Med, 361, pp.1748~1759 (2009)
- Conway PH, "Recurrent urinary tract infections in children : risk factors and association with prophylactic antimicrobials", JAMA, 298, pp.179~186 (2007)
- Bessesen DH, "Update on obesity", J Clin Endocrinol Metab, 93, pp.2027~2034 (2008)
- Wyrick S, "What role does body mass index play in hospital admission rates from the pediatric emergency department?", Pediatr Emerg Care, 29, pp.974~978 (2013)
- Cies JJ, "Influence of body mass index and antibiotic dose on the risk of surgical site infections in pediatric clean orthopedic surgery", Surg Infect(Larchmt), 13, pp.371~376 (2012)
- Ragnarsdottir B, "Genetics of innate immunity and UTI susceptibility", Nat Rev Urol, 8, pp.449~468 (2011)
- Ching C, "Innate immunity and urinary tract infection", Pediatr Nephrol, 35, pp.1183~1192 (2020)
- Hannan TJ, "Inhibition of cyclooxygenase-2 prevents chronic and recurrent cystitis", EBioMedicine, 1, pp.46~57 (2014)
- Forster CS, "Urinary NGAL deficiency in recurrent urinary tract infections", Pediatr Nephrol, 32, pp.1077~1080 (2017)
- Jaksic E, "Diagnostic role of initial renal cortical scintigraphy in children with the first episode of acute pyelonephritis", Ann Nucl Med, 25, pp.37~43 (2011)
- Piepsz A, "Guidelines for 99mTc-DMSA scintigraphy in children", Eur J Nucl Med, 28, pp.BP37~41 (2001)
- Fernbach SK, "Ultrasound grading of hydronephrosis : introduction to the system used by the Society for Fetal Urology", Pediatr Radiol, 23, pp.478~480 (1993)
- Kim JH, "The 2017Korean National Growth Charts for children and adolescents : development, improvement, and prospects", Korean J Pediatr, 61, pp.135~149 (2018)
- Braga LH, "Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis", Pediatrics, 131, pp.e251~61 (2013)
- Chong SL, "Risk factors for imaging abnormalities after the first febrile urinary tract infection in infants ≤3 months old : a retrospective cohort study", BMJ Paediatr Open, 7, pp.e001687~ (2023)
- Honkinen O, "Bacteremic urinary tract infection in children", Pediatr Infect Dis J, 19, pp.630~634 (2000)
- Yim HE, "Impact of early-life weight status on urinary tract infections in children : a nationwide population-based study in Korea", Epidemiol Health, 43, pp.e2021005~ (2021)
- de Onis M, "The World Health Organization Global Database on Child Growth and Malnutrition : methodology and applications", Int J Epidemiol, 32, pp.518~526 (2003)
- Alemayehu GM, "Severity of malnutrition among underweight children and family-related factors : a cross-sectional analysis of data from the 2019 Ethiopian Demographic and Health Survey(EDHS)", Health Sci Rep, 5, pp.e860~ (2022)
- Bagga A, "Bacteriuria and urinary tract infections in malnourished children", Pediatr Nephrol, 18, pp.366~370 (2003)
- Babirekere-Iriso E, "Bacteraemia in severely malnourished children in an HIV-endemic setting", Ann Trop Paediatr, 26, pp.319~328 (2006)
- Deo SS, "Elevated levels of secretory immunoglobulin A(sIgA)in urinary tract infections", Indian J Pediatr, 71, pp.37~40 (2004)
- Riedasch G, "Does low urinary sIgA predispose to urinary tract infection?", Kidney Int, 23, pp.759~763 (1983)
- Sullivan DA, "Influence of severe protein malnutrition on rat lacrimal, salivary and gastrointestinal immune expression during development, adulthood and ageing", Immunology, 78, pp.308~317 (1993)
- Xu SY, "Purification and characterization of a human neutrophil lipocalin(HNL)from the secondary granules of human neutrophils", Scand J Clin Lab Invest, 54, pp.365~376 (1994)
- Berger T, "Lipocalin 2-deficient mice exhibit increased sensitivity to Escherichia coli infection but not to ischemia-reperfusion injury", Proc Natl Acad Sci U S A, 103, pp.1834~1839 (2006)
- Uwaezuoke SN, "The prevalence of urinary tract infection in children with severe acute malnutrition : a narrative review", Pediatric Health Med Ther, 7, pp.121~127 (2016)
- Shaikh S, "Correlation of C-reactive protein and total leukocyte count in acute infections : a single center study", Pak J Surg, 35, pp.271~274 (2019)
- Naess A, "Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever", Infection, 45, pp.299~307 (2017)
- Condron C, "Neutrophil bactericidal function is defective in patients with recurrent urinary tract infections", Urol Res, 31, pp.329~334 (2003)
- Frendeus B, "Interleukin 8 receptor deficiency confers susceptibility to acute experimental pyelonephritis and may have a human counterpart", J Exp Med, 192, pp.881~890 (2000)
- Schiwon M, "Crosstalk between sentinel and helper macrophages permits neutrophil migration into infected uroepithelium", Cell, 156, pp.456~468 (2014)