title: Treatment of occult reflux lowers the incidence rate of pediatric febrile urinary tract infection.
abstract: OBJECTIVE
  To examine whether vesicourethral reflux diagnosed by positioned instillation of contrast (PIC-VUR) shows clinical importance by comparing the incidence rates of febrile urinary tract infection (FUTI) before and after treatment of PIC-VUR.
  
  
  METHODS
  Beginning in 2001 we used a multi-institutional registry to prospectively enroll consecutive pediatric patients with a history of FUTI without VUR according to voiding cystourethrogram (VCUG) and yet who show PIC-VUR. Treatment of PIC-VUR was with prophylactic antimicrobials or antireflux surgery. The post-treatment occurrence of FUTI was tracked.
  
  
  RESULTS
  A total of 14 centers enrolled 118 patients (mean age, 7.2 years; range, 0.5 to 20 years). Parents self-selected the treatment of PIC-VUR as endoscopic injection (104), ureteral reimplantation (3), or antimicrobial prophylaxis (11). Study intervals surveying for FUTI before PIC (mean, 12 months; range, 1 to 17 years) and after PIC treatment (mean, 11 months; range, 0 to 3 years) were not significantly different. Overall the incidence rate for FUTI decreased significantly from 0.16 per patient per month before PIC-VUR treatment to 0.008 per patient per month after treatment (rate ratio 20; 95% confidence interval 11 to 36). The post-treatment rate of FUTI in patients treated with antibiotics versus surgery was not significantly different (rate ratio 2.5; 95% confidence interval 0.33 to 27).
  
  
  CONCLUSIONS
  The diagnosis of PIC-VUR is clinically important because children treated for PIC-VUR with either antimicrobial prophylaxis or surgery show a significant reduction in the incidence rate of FUTI. This is the basis for a current prospective study randomizing patients with PIC-VUR to treatment or observation.
authors.affiliation: Children's Memorial Hospital, Chicago, Illinois 60611, USA. jhagerty@childrensmemorial.org
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hagerty
authors.forename: Max
authors.initials: M
authors.lastname: Maizels
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirsch
authors.forename: Dennis
authors.initials: D
authors.lastname: Liu
authors.forename: Kourosh
authors.initials: K
authors.lastname: Afshar
authors.forename: Timothy
authors.initials: T
authors.lastname: Bukowski
authors.forename: Paolo
authors.initials: P
authors.lastname: Caione
authors.forename: Yves
authors.initials: Y
authors.lastname: Homsy
authors.forename: Theresa
authors.initials: T
authors.lastname: Meyer
authors.forename: William
authors.initials: W
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D003558:Cystoscopy; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy
chemical_list: D003287:Contrast Media