title: Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring.
abstract: OBJECTIVE
  To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis.
  
  
  METHODS
  This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring.
  
  
  RESULTS
  Children with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09-3.93]) and presence of renal scarring on the baseline (99m)Tc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22-6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86-4.87]).
  
  
  CONCLUSIONS
  VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD.
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Pediatrics and Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; keren@email.chop.edu.
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.affiliation: University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania;
authors.forename: Nader
authors.initials: N
authors.lastname: Shaikh
authors.affiliation: Division of Urology, Children's National Health System, Washington, DC; and.
authors.forename: Hans
authors.initials: H
authors.lastname: Pohl
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gravens-Mueller
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Ivanova
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Lisa
authors.initials: L
authors.lastname: Zaoutis
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Melissa
authors.initials: M
authors.lastname: Patel
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Rachel
authors.initials: R
authors.lastname: deBerardinis
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Allison
authors.initials: A
authors.lastname: Parker
authors.affiliation: University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania;
authors.forename: Sonika
authors.initials: S
authors.lastname: Bhatnagar
authors.affiliation: University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania;
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Haralam
authors.affiliation: University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania;
authors.forename: Marcia
authors.initials: M
authors.lastname: Pope
authors.affiliation: University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania;
authors.forename: Diana
authors.initials: D
authors.lastname: Kearney
authors.affiliation: Division of Urology, Children's National Health System, Washington, DC; and.
authors.forename: Bruce
authors.initials: B
authors.lastname: Sprague
authors.affiliation: Division of Urology, Children's National Health System, Washington, DC; and.
authors.forename: Raquel
authors.initials: R
authors.lastname: Barrera
authors.affiliation: Division of Urology, Children's National Health System, Washington, DC; and.
authors.forename: Bernarda
authors.initials: B
authors.lastname: Viteri
authors.affiliation: Division of Urology, Children's National Health System, Washington, DC; and.
authors.forename: Martina
authors.initials: M
authors.lastname: Egigueron
authors.affiliation: Division of Urology, Children's National Health System, Washington, DC; and.
authors.forename: Neha
authors.initials: N
authors.lastname: Shah
authors.affiliation: University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania;
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hoberman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002675:Child, Preschool; D002921:Cicatrix / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007668:Kidney / Q000473:pathology*; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000175:diagnosis
chemical_list: D000900:Anti-Bacterial Agents