title: [Comparison of two protocols of febrile urinary tract infection management in children].
abstract: OBJECTIVE
  To compare two first febrile urinary tract infection (UTI) management protocols with regards to the diagnosis of high-grade vesicoureteral reflux (VUR) and cost.
  
  
  METHODS
  This study compared two cohorts of children under 16 years of age, admitted for a first episode of febrile UTI. The first group (in 2005) was managed according to previous recommendations (IV treatment and cystography performed for all children under 3 years of age). The second group (in 2006) was managed according to age and procalcitonin level. High-grade VUR frequency, UTI recurrence, hospitalization rate, and cost were compared between the two cohorts.
  
  
  RESULTS
  A total of 225 children were included in 2005 and 116 in 2006. High-grade VUR was found in 6.2 and 9.5% of the patients in 2005 and 2006, respectively (P=0.274). There was no statistically significant difference in the UTI recurrence rate between the two cohorts (5.3% in 2005 and 8.6% in 2006; P=0.237). The mean cost of an episode of febrile UTI was not significantly different in 2005 and 2006 (€2235 in 2005, €2256 in 2006; P=0.902), but was lower for children older than 6 months in 2006 (€1292 versus €1882 in 2005; P=0.0042).
  
  
  CONCLUSIONS
  Our management protocol for a first febrile UTI episode in children based on procalcitonin levels seems to be suitable for the diagnosis of high-grade VUR. The hospitalization rate and the mean cost of management for children older than 6 months of age was significantly reduced in 2006. The management guidelines for a first occurrence of febrile UTI in children should be reconsidered.
authors.affiliation: Clinique médicale pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 7, Quai-Moncousu, 44093 Nantes cedex, France.
authors.forename: T
authors.initials: T
authors.lastname: Blanchais
authors.forename: A
authors.initials: A
authors.lastname: Legrand
authors.forename: E
authors.initials: E
authors.lastname: Allain Launay
authors.forename: M-D
authors.initials: MD
authors.lastname: Leclair
authors.forename: J
authors.initials: J
authors.lastname: Caillon
authors.forename: G
authors.initials: G
authors.lastname: Roussey-Kesler
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000652:urine; D002116:Calcitonin / Q000652:urine; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000382:microbiology; D005602:France; D006801:Humans; D007223:Infant; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D008297:Male; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000652:urine; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology* / Q000652:urine; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000652:urine
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide