BACTERIAL VIRULENCE FACTORS AND THEIR ASS OCIATION WITH FUNCTIONAL AND ANATOMICAL ABNORMALITIES AND RECURRENCE OF URINARY-TRACT INFECTIONS IN CHILDREN

Background: Urinary tract infections in children are associated with f unctional and anatomical abnormalities of the urinary tract, they tend to recur and can cause permanent kidney damage. Aim: To study in chil dren with urinary tract infections, microbiological factors associated to recurrence, functional and anatomical abnormalities of the urinary tract. Patients and methods: A prospective sample of children was inc orporated into a follow-up protocol after their first episode of bacte riologically-demonstrated urinary tract infection., In all patients an abdominal ultrasound examination and a mictional urethrocystography w ere done and the presence of fimbriae was studied in isolated strains of Escherichia coli. Results: Two hundred fifteen cases had an adequat e adherence to the study protocol, 190 caused by E coli. Fimbriated E coli strains were isolated with greater frequency from children with p yelonephritis than from those with a low urinary tract infection (50 a nd 28% respectively). The absence of fimbriae in E coli strains was as sociated with a higher risk of recurrent infections (odds ratio= 3, co nfidence intervals= 2-9.2) and an abnormal urethrocystography (odds ra tio= 3, confidence intervals= 1.1-10.2). Conclusions: These data are c onsistent with foreign reports and support the need to study adhesins in E coli strains isolated from children with urinary tract infections .