title: Children with a febrile urinary tract infection and a negative radiologic workup: factors predictive of recurrence.
abstract: OBJECTIVE
  To determine the recurrence rate and risk factors for urinary tract infection (UTI) in children who present with a febrile UTI and have a negative radiologic evaluation. Febrile UTIs with no urinary tract abnormalities are a common cause of morbidity in children.
  
  
  METHODS
  We performed a retrospective review of all children referred to our medical center after a febrile UTI.
  
  
  RESULTS
  We reviewed 850 charts. Of 850 children, 78 had had a febrile UTI and normal ultrasound and voiding cystourography findings. Of the 78 children, 25 had had a recurrent UTI (3 boys and 22 girls). Forty-five percent of the girls with a febrile UTI developed a recurrent UTI and 14% of the boys had a recurrent UTI (P = 0.02). Three boys (two younger than 1 year of age) were uncircumcised and had one recurrent febrile UTI. Eleven (39%) of 28 girls who first presented at younger than 1 year of age and 7 (58%) of 12 girls who presented at 5 years of age or older had recurrent UTIs. The recurrence rate in the 2 to 5-year-old age group was 24% (4 of 17). Seven of the older girls exhibited symptoms of dysfunctional elimination syndrome.
  
  
  CONCLUSIONS
  In children with a febrile UTI and a negative radiologic evaluation, recurrence was more common in girls. Boys who were uncircumcised may be at an increased risk of infection during the first year of life. In girls, the age at the time of the first infection was not predictive of recurrence. Although dysfunctional voiding and elimination may contribute to recurrent febrile UTIs in young children, an association seems to be present in children 5 years old and older.
authors.affiliation: Department of Urology, University of California, San Francisco, School of Medicine, San Francisco Children's Hospital, San Francisco, California 94143, USA.
authors.forename: Gerald C
authors.initials: GC
authors.lastname: Mingin
authors.forename: Angie
authors.initials: A
authors.lastname: Hinds
authors.forename: Hiep T
authors.initials: HT
authors.lastname: Nguyen
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Baskin
mesh_terms: D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D003248:Constipation / Q000150:complications; D005260:Female; D005334:Fever / Q000209:etiology*; D006184:Habits; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014039:Toilet Training; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*