AUTHOR=Harper Luke , Botto Nathalie , Peycelon Matthieu , Michel Jean-Luc , Leclair Marc-David , Garnier Sarah , Clermidi Pauline , Arnaud Alexis P. , Dariel Anne-Laure , Dobremez Eric , Faure Alice , Fourcade Laurent , Boudaoud Nadia , Chaussy Yann , Collin Fideline , Huiart Laetitia , Ferdynus Cyril , Bocquet Valery , Sauvat Frederique TITLE=Risk factors for febrile urinary tract infection in boys with posterior urethral valves JOURNAL=Frontiers in Pediatrics VOLUME=10 YEAR=2022 URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.971662 DOI=10.3389/fped.2022.971662 ISSN=2296-2360 ABSTRACT=Objective

Boys with posterior urethral valves (PUV) present an increased risk of febrile urinary tract infection (fUTI). Identifying specific risk factors could allow for tailoring UTI prevention. The aim of this study was to use the data from the CIRCUP randomized controlled trial data to identify patient characteristics associated with a higher risk of fUTI.

Patients and methods

We performed a secondary analysis of the data from the CIRCUP randomized trial which included boys with PUV, randomized to circumcision and antibiotic prophylaxis vs. antibiotic prophylaxis alone and followed for 2 years. There was only 1 episode of fUTI in the circumcision group vs. 17 in the uncircumcised group. We therefore only studied the antibiotic prophylaxis alone group and compared age at prenatal diagnosis, size and weight at birth, presence of dilating VUR at diagnosis, abnormal DMSA scan at 2 months, and nadir creatinine between children who presented a fUTI and those who did not, as well as age at first episode of fUTI.

Results

The study group consisted of 42 patients of which 17 presented at least on fUTI. Presence of dilating VUR was significantly associated with risk of fUTI (p = 0.03), OR: 6 [CI 95% = (1.13–27.52)]. None of the other parameters were associated with increased risk of fUTI. We observed three distinct time periods for presenting a fUTI with a decrease in infection rate after the first 40 days of life, then at 240 days of life.

Conclusion

In boys with PUV, presence of high-grade VUR is associated with a higher risk of presenting a fUTI. The rate of febrile UTIs seems to decrease after 9 months.