The Swedish reflux trial in children: III. Urinary tract infection pattern.
OBJECTIVE
We evaluated the difference in the febrile urinary tract infection rate in small children with dilating vesicoureteral reflux randomly allocated to 3 management alternatives, including antibiotic prophylaxis, endoscopic treatment or surveillance only as the control.


METHODS
At 23 centers a total of 203 children were included in the study, including 128 girls and 75 boys 1 to younger than 2 years. Vesicoureteral reflux grade III in 126 cases and IV in 77 was detected after a febrile urinary tract infection (194) after prenatal screening (9). Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years. The febrile urinary tract infection rate was analyzed by the intent to treat principle.


RESULTS
We noted a total of 67 febrile recurrences in 42 girls and a total of 8 in 7 boys (p = 0.0001). There was a difference in the recurrence rate among treatment groups in girls with febrile infection in 8 of 43 (19%) on prophylaxis, 10 of 43 (23%) with endoscopic therapy and 24 of 42 (57%) on surveillance (p = 0.0002). In girls the recurrence rate was associated with persistent reflux after 2 years (p = 0.0095). However, reflux severity (grade III or IV) at study entry did not predict recurrence.


CONCLUSIONS
In this randomized, controlled trial there was a high rate of recurrent febrile urinary tract infection in girls older than 1 year with dilating vesicoureteral reflux at study entry but not in boys. Antibiotic prophylaxis and endoscopic treatment decreased the infection rate.
Brandström
Per
P
Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
Esbjörner
Elisabeth
E
Herthelius
Maria
M
Swerkersson
Svante
S
Jodal
Ulf
U
Hansson
Sverker
S
D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D004724:Endoscopy; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D012008:Recurrence; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013548:Sweden / Q000453:epidemiology; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
D019783:Technetium Tc 99m Dimercaptosuccinic Acid