Risk factors for recurrent urinary tract infection in preschool children

Objective: Children with urinary tract infections (UTI) are at risk of rena l scarring which may lead to impaired renal function and hypertension. This study examines the risk factors that predispose to recurrent UTI in childr en and the role of recurrent UTI in renal scarring. Methodology: A group of 290 children under 5 years of age with a first symp tomatic UTI were studied. Micturating cystourethrogram and dimercaptosuccin ic acid (DMSA) renal scintigraphy were performed at entry, and DMSA was rep eated 1 year later. Two hundred and sixty-one children (90%) were followed up at 1 year. Results: There were 46 confirmed recurrent infections in 34 children, a rec urrence rate of 12%. Multiple recurrence occurred in 14/34 (34%) children. Age of less than 6 months on entry independently predicted for recurrent UT I (odds ratio (OR): 2.9)). Compliance with prophylactic antibiotics fell th roughout the year of follow up. Vesicoureteric reflux (VUR) was present in 14/34 (34%) or the group with recurrent UTI, 69/256 (27%) without recurrenc e. Urinary tract infection was significantly associated with bilateral and intrarenal reflux; grade 3-5 reflux independently predicted for recurrent U TI (OR: 3.5). Recurrent UTI was significantly associated with high grade DM SA defects on entry, renal parenchymal defects at 1 year follow up, and new defects at 1 year. Conclusions: The independent risk factors for recurrent UTI identified by t his study were an age of less than 6 months at the index UTI and grade 3-5 VUR. These findings suggest more selective targeting may minimize problems associated with prophylaxis and improve outcomes for children with urine in fection.