title: Risk factors for febrile urinary tract infection in infants with prenatal hydronephrosis: comprehensive single center analysis.
abstract: OBJECTIVE
  We assessed risk factors for urinary tract infection in children with prenatal hydronephrosis
  
  
  METHODS
  We identified 376 infants with prenatal hydronephrosis in an institutional database. The occurrence of febrile urinary tract infection in the first 2 years of life was ascertained by chart review. Febrile urinary tract infection was defined as a positive culture from a catheterized urine specimen in a patient with a fever of 38.0C or greater. Multivariate logistic regression was used to assess gender, circumcision status, hydronephrosis grade, vesicoureteral reflux grade and antibiotic prophylaxis as predictors of the risk of urinary tract infection.
  
  
  RESULTS
  Included in analysis were 277 males and 99 females. Hydronephrosis was high grade in 128 infants (34.0%) and vesicoureteral reflux was present in 79 (21.0%). Antibiotic prophylaxis was prescribed in 60.4% of patients, preferentially to females vs males (70.7% vs 56.7%), those with high vs low grade hydronephrosis (70.3% vs 55.2%) and those with vs without vesicoureteral reflux (96.2% vs 50.8%). On multivariate analysis there was an association between high grade hydronephrosis and an increased risk of urinary tract infection (adjusted OR 2.40, 95% CI 1.26-4.56). Females (adjusted OR 3.16, 95% CI 0.98-10.19) and uncircumcised males (adjusted OR 3.63, 95% CI 1.18-11.22) were also at higher risk than circumcised males. Antibiotic prophylaxis was not associated with a decreased risk of urinary tract infection (adjusted OR 0.93, 95% CI 0.45-1.94).
  
  
  CONCLUSIONS
  High grade hydronephrosis, female gender and uncircumcised status in males are independent risk factors for febrile urinary tract infection in infants with prenatal hydronephrosis. Antibiotic prophylaxis did not reduce the risk of urinary tract infection in the study group.
authors.affiliation: Division of Urology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Piotr
authors.initials: P
authors.lastname: Zareba
authors.affiliation: Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Lorenzo
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada. Electronic address: braga@mcmaster.ca.
authors.forename: Luis H
authors.initials: LH
authors.lastname: Braga
mesh_terms: D019072:Antibiotic Prophylaxis; D002944:Circumcision, Male; D024881:Drug Resistance, Bacterial; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology; D005334:Fever / Q000150:complications; D006801:Humans; D006869:Hydronephrosis / Q000150:complications*; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control
keywords: antibiotic prophylaxis; hydronephrosis; kidney; prenatal diagnosis; urinary tract infections