Document Type : original article
Authors
1
Department of Community Medicine, Leishmaniasis Research Center, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
2
Student Research Committee, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
3
Department of Neonatology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar Iran.
4
Department of Pediatric Nephrology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Abstract
Background: Urinary Tract Infection (UTI) is the most common serious bacterial infection in infancy and childhood. Identifying factors associated with its recurrence is crucial. This study aimed to determine the prevalence and correlation of abnormalities reported in urinary ultrasonography and other imaging studies in children hospitalized with UTI.
Materials and Methods: This cross-sectional study was conducted on 116 children under 16 years of age diagnosed with UTI and admitted to Heshmatieh Hospital in Sabzevar in 2019. UTI was defined as the growth of ≥10⁵ colony-forming units (CFU)/mL of a single uropathogen on urine culture, accompanied by pyuria (≥5 white blood cells per high-power field) or clinical symptoms. Recurrent UTI was defined as ≥2 episodes of febrile UTI or ≥3 episodes of non-febrile UTI within 12 months. After obtaining informed consent, demographic data, clinical presentation, urinalysis, urine culture results, and findings from renal and urinary tract imaging (Ultrasound, VCUG, and DMSA scan) were recorded. Median and interquartile range (IQR) were reported for skewed continuous variables. Proportions are presented with 95% confidence intervals (CI). Data were analyzed using SPSS version 20, with Chi-square and Fisher's exact tests employed for comparisons. Odds ratios (OR) with 95% CI were calculated for significant associations.
Results: The mean age was 40.45 ± 48.38 months (median: 18.0 months, IQR: 6.0–60.0), with 75% (95% CI: 66.2–82.4%) being female. The most common presenting symptom was fever (56%, 95% CI: 46.9–64.8%). E. coli (46.6% of all patients, 95% CI: 37.5–55.9%; representing 87.1% of positive cultures) was the most frequently isolated pathogen. Radiological investigations revealed urinary stones in 7.8% (95% CI: 3.8–14.0%), hydronephrosis in 16.4% (95% CI: 10.4–23.9%), and vesicoureteral reflux (VUR) in 57.1% of those imaged (95% CI: 28.9–82.3%) (with 37.5% Grade III and 62.5% Grade IV). Other structural anomalies were found in 23.3% (95% CI: 16.1–31.9%). A significant correlation was observed between the presence of hydronephrosis (OR = 5.63, 95% CI: 1.97–16.05, p=0.001), VUR (OR undefined due to zero events in non-recurrent group, p=0.024), and other structural abnormalities (OR = 5.43, 95% CI: 2.17–13.58, p<0.001) with a history of recurrent UTI.
Conclusion: A significant proportion of children with UTIs, particularly those with recurrent infections, have underlying structural and functional urinary tract abnormalities. Comprehensive renal and urinary tract imaging in these high-risk children is essential for timely identification and management to prevent recurrent infections and potential long-term complications.
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