title: Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring.
abstract: Existing data regarding the association between delayed initiation of antimicrobial therapy and the development of renal scarring are inconsistent.
  
  
  
  To determine whether delay in the initiation of antimicrobial therapy for febrile urinary tract infections (UTIs) is associated with the occurrence and severity of renal scarring.
  
  
  
  Retrospective cohort study that combined data from 2 previously conducted longitudinal studies (the Randomized Intervention for Children With Vesicoureteral Reflux trial and the Careful Urinary Tract Infection Evaluation Study). Children younger than 6 years with a first or second UTI were followed up for 2 years.
  
  
  
  Duration of the child's fever prior to initiation of antimicrobial therapy for the index UTI.
  
  
  
  New renal scarring defined as the presence of photopenia plus contour change on a late dimercaptosuccinic acid renal scan (obtained at study exit) that was not present on the baseline scan.
  
  
  
  Of the 482 children included in the analysis, 434 were female (90%), 375 were white (78%), and 375 had vesicoureteral reflux (78%). The median age was 11 months. A total of 35 children (7.2%) developed new renal scarring. Delay in the initiation of antimicrobial therapy was associated with renal scarring; the median (25th, 75th percentiles) duration of fever prior to initiation of antibiotic therapy in those with and without renal scarring was 72 (30, 120) and 48 (24, 72) hours, respectively (P = .003). Older age (OR, 1.03; 95% CI, 1.01-1.05), Hispanic ethnicity (OR, 5.24; 95% CI, 2.15-12.77), recurrent urinary tract infections (OR, 0.97; 95% CI, 0.27-3.45), and bladder and bowel dysfunction (OR, 6.44; 95% CI, 2.89-14.38) were also associated with new renal scarring. Delay in the initiation of antimicrobial therapy remained significantly associated with renal scarring even after adjusting for these variables.
  
  
  
  Delay in treatment of febrile UTIs and permanent renal scarring are associated. In febrile children, clinicians should not delay testing for UTI.
authors.affiliation: University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania.
authors.forename: Nader
authors.initials: N
authors.lastname: Shaikh
authors.affiliation: Wayne State University, Children's Hospital of Michigan, Detroit.
authors.forename: Tej K
authors.initials: TK
authors.lastname: Mattoo
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania4Associate Editor, JAMA Pediatrics.
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.affiliation: Department of Biostatistics, University of North Carolina at Chapel Hill.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Ivanova
authors.affiliation: Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill.
authors.forename: Gang
authors.initials: G
authors.lastname: Cui
authors.affiliation: National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Marva
authors.initials: M
authors.lastname: Moxey-Mims
authors.affiliation: George Washington University School of Medicine, Children's National Medical Center, Division of Radiology, Washington, DC.
authors.forename: Massoud
authors.initials: M
authors.lastname: Majd
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Harvey A
authors.initials: HA
authors.lastname: Ziessman
authors.affiliation: University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Hoberman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology*; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents