title: Characteristics of first urinary tract infection with fever in children: a prospective clinical and imaging study.
abstract: BACKGROUND
  Our objective is to provide the clinical characteristics, uropathogen frequencies, and antimicrobial resistance rates of first urinary tract infection (UTI) diagnosed in febrile Belgian children. The ability of noninvasive ultrasound to detect renal abnormalities and vesicoureteral reflux (VUR) in these patients was also assessed.
  
  
  METHODS
  We prospectively followed (median, 20 months) 209 children treated for first febrile UTI. Renal ultrasound (US) and voiding cystourethrography examinations were performed in all patients.
  
  
  RESULTS
  Among these children, 63% were females and 37% were males, and 75% of them had their first UTI before the age of 2 years. The most common causative agent was Escherichia coli (91% of cases) with high rate resistance to ampicillin (58%) and trimethoprim/sulfamethoxazole (38%). Of these children, 25% had evidence of VUR (15 boys and 38 girls). VUR was of low grade in 85% of cases. The overall performance of renal US as a diagnostic test to detect significant uropathies excluding low-grade VUR was excellent; the sensitivity attained 97% and the specificity 94%.
  
  
  CONCLUSIONS
  Girls represent 63% of cases with first UTI. For 91% of UTIs, Escherichia coli is held responsible with a high rate of resistance to ampicillin and trimethoprim/sulfamethoxazole. US is an excellent screening tool that allows avoidance of unjustified voiding cystourethrography studies.
authors.affiliation: Department of Pediatric Nephrology, Hôpital Universitaire des Enfants-Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium. khalid.ismaili@huderf.be
authors.forename: Khalid
authors.initials: K
authors.lastname: Ismaili
authors.forename: Karl Martin
authors.initials: KM
authors.lastname: Wissing
authors.forename: Ksenija
authors.initials: K
authors.lastname: Lolin
authors.forename: Phu Quoq
authors.initials: PQ
authors.lastname: Le
authors.forename: Catherine
authors.initials: C
authors.lastname: Christophe
authors.forename: Philippe
authors.initials: P
authors.lastname: Lepage
authors.forename: Michelle
authors.initials: M
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*