title: Recurrent Urinary Tract Infections in Children With Bladder and Bowel Dysfunction.
abstract: BACKGROUND
  Little generalizable information is available on the outcomes of children diagnosed with bladder and bowel dysfunction (BBD) after a urinary tract infection (UTI). Our objectives were to describe the clinical characteristics of children with BBD and to examine the effects of BBD on patient outcomes in children with and without vesicoureteral reflux (VUR).
  
  
  METHODS
  We combined data from 2 longitudinal studies (Randomized Intervention for Children With Vesicoureteral Reflux and Careful Urinary Tract Infection Evaluation) in which children <6 years of age with a first or second UTI were followed for 2 years. We compared outcomes for children with and without BBD, children with and without VUR, and children with VUR randomly assigned to prophylaxis or placebo. The outcomes examined were incidence of recurrent UTIs, renal scarring, surgical intervention, resolution of VUR, and treatment failure.
  
  
  RESULTS
  BBD was present at baseline in 54% of the 181 toilet-trained children included; 94% of children with BBD reported daytime wetting, withholding maneuvers, or constipation. In children not on antimicrobial prophylaxis, 51% of those with both BBD and VUR experienced recurrent UTIs, compared with 20% of those with VUR alone, 35% with BBD alone, and 32% with neither BBD nor VUR. BBD was not associated with any of the other outcomes investigated.
  
  
  CONCLUSIONS
  Among toilet-trained children, those with both BBD and VUR are at higher risk of developing recurrent UTIs than children with isolated VUR or children with isolated BBD and, accordingly, exhibit the greatest benefit from antimicrobial prophylaxis.
authors.affiliation: Divisions of General Academic Pediatrics, and nader.shaikh@chp.edu.
authors.forename: Nader
authors.initials: N
authors.lastname: Shaikh
authors.affiliation: Divisions of General Academic Pediatrics, and.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hoberman
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.affiliation: Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
authors.forename: Nathan
authors.initials: N
authors.lastname: Gotman
authors.affiliation: Urology, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania;
authors.forename: Steven G
authors.initials: SG
authors.lastname: Docimo
authors.affiliation: Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois;
authors.forename: Ranjiv
authors.initials: R
authors.lastname: Mathews
authors.affiliation: Divisions of General Academic Pediatrics, and.
authors.forename: Sonika
authors.initials: S
authors.lastname: Bhatnagar
authors.affiliation: Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
authors.forename: Anastasia
authors.initials: A
authors.lastname: Ivanova
authors.affiliation: Children's Hospital of Michigan, Wayne State University, Detroit, Michigan;
authors.forename: Tej K
authors.initials: TK
authors.lastname: Mattoo
authors.affiliation: National Institute of Diabetes, and Digestive and Kidney Diseases, Bethesda, Maryland;
authors.forename: Marva
authors.initials: M
authors.lastname: Moxey-Mims
authors.affiliation: Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
authors.forename: Myra A
authors.initials: MA
authors.lastname: Carpenter
authors.affiliation: Division of Urology, Children's National Medical Center, George Washington University School of Medicine, Washington, District of Columbia; and.
authors.forename: Hans G
authors.initials: HG
authors.lastname: Pohl
authors.affiliation: Division of Pediatric Urology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York.
authors.forename: Saul
authors.initials: S
authors.lastname: Greenfield
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications* / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012008:Recurrence; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000150:complications* / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000150:complications*
chemical_list: D000890:Anti-Infective Agents