title: Escherichia coli virulence patterns may help to predict vesicoureteral reflux in paediatric urinary tract infections.
abstract: OBJECTIVE
  Ultrasound and biological tools are used to predict high-grade vesicoureteral reflux, but other markers are needed to better select patients who need voiding cystography. Our aim was to determine whether studying Escherichia coli virulence factors would help to predict vesicoureteral reflux in patients with their first acute pyelonephritis.
  
  
  METHODS
  We included children presenting with E. coli-related acute pyelonephritis or cystitis. Vesicoureteral reflux was assessed by voiding cystography. Virulence factors were identified by multiplex polymerase chain reaction. Statistical analysis was performed using logistic regression and the mean c-statistic test.
  
  
  RESULTS
  We included 198 patients: 30 with cystitis and 168 with acute pyelonephritis, including 46 with vesicoureteral reflux. High-grade reflux was associated with acute pyelonephritis caused by the E. coli lacking virulence factors papGII (82% versus 47%, p < 0.001) or papC (85% versus 53%, p < 0.001) or belonging to phylogenetic group A or B1. When we added genetic data (lack of papGII, fyuA and phylogenetic groups) to classical predictors of vesicoureteral reflux (ultrasound examination, gender, age), the ability to predict high-grade reflux increased, with the c-statistic rising from 0.88 to 0.93.
  
  
  CONCLUSIONS
  Bacterial virulence factors and clinical factors helped to predict high-grade reflux and may help to avoid unnecessary voiding cystographies.
authors.affiliation: Service de Néphrologie et Dialyse Pédiatrique, Assistance Publique-Hôpitaux de Paris and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Armand Trousseau, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Hogan
authors.affiliation: Service de Microbiologie, Hôpital Robert Debré, AP-HP, Paris, France.
authors.forename: Farah
authors.initials: F
authors.lastname: Mahjoub
authors.affiliation: Service de Néphrologie et Dialyse Pédiatrique, Assistance Publique-Hôpitaux de Paris and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Armand Trousseau, Paris, France.
authors.forename: Anis Skander
authors.initials: AS
authors.lastname: Larakeb
authors.affiliation: Service de Microbiologie, Hôpital Armand Trousseau, AP-HP, Paris, France.
authors.forename: Hoang
authors.initials: H
authors.lastname: Vu Thien
authors.affiliation: Service de Pédiatrie Générale, Hôpital Armand Trousseau, AP-HP, Paris, France.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hosany
authors.affiliation: Service de Néphrologie et Dialyse Pédiatrique, Assistance Publique-Hôpitaux de Paris and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Armand Trousseau, Paris, France.|Université Pierre et Marie Curie (UMPC), Paris, France.
authors.forename: Albert
authors.initials: A
authors.lastname: Bensman
authors.affiliation: Service de Pédiatrie Générale, Hôpital Armand Trousseau, AP-HP, Paris, France.|Université Pierre et Marie Curie (UMPC), Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Grimprel
authors.affiliation: Service de Microbiologie, Hôpital Robert Debré, AP-HP, Paris, France.|Université Paris Diderot, Paris, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Bingen
authors.affiliation: Service de Microbiologie, Hôpital Robert Debré, AP-HP, Paris, France.|Université Paris Diderot, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bonacorsi
authors.affiliation: Service de Néphrologie et Dialyse Pédiatrique, Assistance Publique-Hôpitaux de Paris and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Armand Trousseau, Paris, France.|Université Pierre et Marie Curie (UMPC), Paris, France.
authors.forename: Tim
authors.initials: T
authors.lastname: Ulinski
mesh_terms: D018829:Adhesins, Bacterial / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D001437:Bacteriuria / Q000150:complications* / Q000382:microbiology; D004926:Escherichia coli / Q000235:genetics / Q000472:pathogenicity*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014718:Vesico-Ureteral Reflux / Q000382:microbiology*; D037521:Virulence Factors / Q000235:genetics*
chemical_list: D018829:Adhesins, Bacterial; D001427:Bacterial Toxins; D037521:Virulence Factors
keywords: Escherichia coli infection; urinary tract infection; vesicoureteral reflux