Abstract
Introduction We determined factors associated with abnormal imaging and recurrent infections after
a first febrile urinary tract infection (UTI) in children younger than 3 years.
Materials and Methods We retrospectively reviewed the records of all patients treated at our institute
during the years 2000–2009, for a first febrile UTI in children younger than 3 years,
who underwent ultrasonography and voiding cystourethrography. We evaluated data regarding
factors potentially associated with abnormal ultrasonography and voiding cystourethrography
results and recurrence of infections, and formulated a risk score system to assess
risk of reflux and high-grade reflux.
Results There were 282 patients. The only factor predicting abnormal ultrasonogram was non–Escherichia coli infection. Risk factors for vesicoureteral reflux included abnormal ultrasonogram,
atypical infection, non–E. coli infection and infection recurrence. Patients with no identified risk factors for
vesicoureteral reflux were unlikely to have high-grade reflux. Higher risk scores
were associated with a higher risk for reflux. Non–E. coli infection was the only statistically significant predictor of infection recurrence.
Conclusion All children younger than 3 years with first febrile UTI should undergo ultrasonography.
Thereafter, patients with no predictive factors for vesicoureteral reflux may be followed
up without further imaging. A non–E. coli infection is associated with reflux and infection recurrence.
Keywords
urinary tract infections - vesicoureteral reflux - diagnostic imaging - children
