title: Predicting early recurrent urinary tract infection in pretoilet trained children with vesicoureteral reflux.
abstract: OBJECTIVE
  We identified independent factors predicting recurrent urinary tract infection within 1 year after the first urinary tract infection in pretoilet trained children with vesicoureteral reflux.
  
  
  METHODS
  We retrospectively reviewed the records of infants younger than 2 years with primary vesicoureteral reflux and a history of febrile urinary tract infection. Patients were divided into 2 groups based on the presence or absence of recurrent febrile urinary tract infection. Analysis included age, gender, reflux laterality and grade, abnormalities on dimercapto-succinic acid renal scan and prophylactic antibiotic type. Univariate and multivariate analyses were performed to identify risk factors for recurrent febrile urinary tract infection.
  
  
  RESULTS
  From 2004 to 2007, 78 children met study inclusion criteria. Mean age at the first urinary tract infection was 4 months (range 1 week to 16 months). None of the males were circumcised. Of 78 children 25 (32%) had a recurrent febrile urinary tract infection during 1 year of followup. Univariate analysis showed that bilateral reflux, high grade reflux (IV-V) and abnormal dimercapto-succinic acid scan were statistically significant predictors of early recurrent urinary tract infection (p <0.05). However, on multivariate analysis only an abnormal dimercapto-succinic acid scan showed a significant association with early recurrent urinary tract infection (OR 8.01, 95% CI 2.10-30.51, p = 0.002).
  
  
  CONCLUSIONS
  Abnormal dimercapto-succinic acid renal scan is an important predictor of early recurrent urinary tract infection in pretoilet trained children with vesicoureteral reflux. Whether the explanation lies in congenital or infection related damage, in this patient subgroup careful clinical followup or early surgical management for reflux should be considered.
authors.affiliation: Department of Urology, Kanagawa Children's Medical Center, Minami-ku, Yokohama, Japan. yyamazaki@kcmc.jp
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamazaki
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Shiroyanagi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsuno
authors.forename: Morihiro
authors.initials: M
authors.lastname: Nishi
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D014039:Toilet Training; D014552:Urinary Tract Infections / Q000209:etiology*; D014718:Vesico-Ureteral Reflux / Q000150:complications*