title: Incidence of Urinary Tract Infection Among Siblings of Children With Vesicoureteral Reflux.
abstract: Siblings of children with vesicoureteral reflux (VUR) are at elevated risk of VUR. Screening siblings may identify VUR before a clinical illness such as a urinary tract infection (UTI), but the benefit of screening has not been demonstrated. We sought to determine the incidence of UTI among siblings, and we hypothesized that the sibling UTI rate is similar between screened and unscreened siblings.
  
  
  
  We performed a retrospective cohort analysis using insurance claims data (January 1, 2000, to December 31, 2009). Within each family, we identified the index VUR patient and siblings; we included siblings who were enrolled in the insurance plan from birth for at least 1 year. We identified siblings who were screened for VUR and/or had UTI. We investigated the association of screening and UTI, controlling for patient characteristics and clustering within families.
  
  
  
  Among 617 siblings (associated with 497 index patients), 317 (51%) were girls. Median insurance enrollment time was 53.0 months, with 424 enrolled ≥3 years. Among those with 1 or 3 years of enrollment, the proportions of siblings who experienced UTI was 8.4% (52 of 617) and 10.4% (44 of 424), respectively. Median age at initial UTI was 32.7 months. A total of 223 siblings (36.0%) underwent sibling screening. There was no significant difference in UTI between screened and unscreened siblings (odds ratio 1.57, 95% confidence interval 0.87-2.85; P = .14). In multivariate analysis, screening was not associated with sibling UTI incidence (odds ratio 1.33, 95% confidence interval 0.68-2.60; P = .40).
  
  
  
  Although UTI is relatively common among siblings of VUR patients, there was no statistically significant difference in UTI incidence between screened and unscreened siblings.
authors.affiliation: Department of Surgery, Harvard Medical School, Boston, Mass; Department of Urology, Boston Children's Hospital, Boston, Mass. Electronic address: caleb.nelson@childrens.harvard.edu.
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Nelson
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, Mass.
authors.forename: Tanya
authors.initials: T
authors.lastname: Logvinenko
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008403:Mass Screening; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D035781:Siblings; D014552:Urinary Tract Infections / Q000453:epidemiology*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis*
keywords: screening; siblings; urinary tract infection; vesicoureteral reflux