title: Bacterial pathogens in first febrile urinary tract infection affect breakthrough infections in infants with vesicoureteral reflux treated with prophylactic antibiotics.
abstract: OBJECTIVE
  To investigate the risk factors for recurrent urinary tract infections (UTIs) in infants with vesicoureteral reflux (VUR) and whether bacterial pathogen affected breakthrough UTI or not.
  
  
  METHODS
  We compared children with infantile VUR with recurrent UTI (33 males, 11 females, mean age 3.2 months) and without recurrent UTI (40 males, 7 females, mean age 4.8 months). The following were compared between the 2 groups: sex, timing of UTI episode, bacterial growth on urine culture, degree and bilaterality of the reflux, hydronephrosis, renal scar, and delayed ureteral excretion of refluxed contrast on voiding cystourethrogram (VCUG).
  
  
  RESULTS
  Univariate Cox survival-time regression showed that younger age at first UTI, a non-Escherichia coli strain, bilateral and VUR, high-grade VUR, and hydronephrosis on initial ultrasonography (USG) significantly increased the risks of recurrent UTI (P <.05 each). In multivariate analysis, timing of the UTI episode (P = .015), a non-E. coli strain (P = .003), high grade (P = .012), and bilateral VUR (P = .002) were independently associated with increased risk of recurrent UTI. Non-E. coli strains were identified in 60% and 33% of infants with and without recurrent UTI, respectively.
  
  
  CONCLUSIONS
  During the first year of life, the earlier the first UTI then the higher the chance is for recurrent UTIs. Higher grades of reflux, bilateral VUR, and the first infection by a non-E. coli strain all significantly increase the risk of recurrent UTIs.
authors.affiliation: Department of Urology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Sungchan
authors.initials: S
authors.lastname: Park
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Song
authors.forename: Chunwoo
authors.initials: C
authors.lastname: Lee
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Kun Suk
authors.initials: KS
authors.lastname: Kim
mesh_terms: D019072:Antibiotic Prophylaxis; D002176:Candida albicans; D002177:Candidiasis / Q000150:complications; D016971:Citrobacter freundii; D016972:Enterobacter cloacae; D004756:Enterobacteriaceae Infections / Q000150:complications / Q000382:microbiology* / Q000517:prevention & control*; D004926:Escherichia coli; D005260:Female; D005334:Fever / Q000382:microbiology; D006801:Humans; D006869:Hydronephrosis / Q000150:complications; D007223:Infant; D041121:Klebsiella oxytoca; D007711:Klebsiella pneumoniae; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011513:Proteus mirabilis; D011514:Proteus vulgaris; D012008:Recurrence; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014552:Urinary Tract Infections / Q000382:microbiology* / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000188:drug therapy
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination