Comprehensive analysis of some risk factors in the formation of a recurrent course of urinary tract infection in children
DOI:
https://doi.org/10.14739/2310-1210.2020.4.208362Keywords:
urinary tract infection, risk factors, childrenAbstract
The aim – to study the risk factors for the formation of recurrent urinary tract infection (UTI) in children with the determination of their prognostic value, both in single-factor and multifactorial impact.
Materials and methods. A total of 2 235 children aged between 1 month to 18 years with nephrological diseases were examined. To assess the risk factors for recurrent UTI in the study population, the patients were divided into groups: with recurrent UTI – 1 (n = 447), without UTI– 0 (n = 1788). 14 traits were taken from the list of studied factors: age <1 year; female gender; ARVI ≥3 episodes over 6 months; undifferentiated connective tissue disease; kidney cystic formations; hydronephrosis and other abnormalities; vesico-ureteric reflux; neurogenic bladder, enuresis; synechia, phimosis; no deworming in the last 6 months; constipation or irritable bowel syndrome; crystalluria, accumulation of salts according to ultrasound; antibacterial therapy in the next 3 months; the presence of resistant urological strains.
Results. The one-factor analysis allowed to remove statistically insignificant risk factors. As a result of multivariate analysis, a multiple logistic model was developed for the personalized prediction of a recurrent UTI in a child: odds = exp (0.712 × X1+ 3.808 × X2+ 6.982 × Х6 + 2.248×X7+ 0.165 × Х8+ 0.300 × X9+ 0.200 × X10+ 0.306 × X11+ 0.196 × X12+ 0.217 × X13+ 0.440 × X14 + (-3.489)), where Xn is a variable (or factor) which equals 1 in the case of a factor, and 0 – in the absence of a factor. The mathematical model of regression showed high statistical significance and informativeness based on the results of its testing, χ2 = 161.9; P < 0.001.
Conclusions. Factors such as frequent ARVI, undifferentiated connective tissue disease, kidney cystic formations did not present a risk of recurrent UTI episodes. The dominating factors in UTI recurrences were the following: female sex increased the chance of UTI in a child almost 12 times (RR = 11.898 ± 0.252 [7.255; 19.514], P < 0.001); hydronephrosis – 11 times (RR = 10.968 ± 0.419 [4.825; 24.933], P < 0.001); vesico-ureteric reflux – 8 times (8.308 ± 0.221 [5.380; 12.804], P < 0.05); age <1 year – 4 times (RR = 3.73 ± 0.165 [2.702; 5.158], P < 0.05). Other factors influenced the development of UTI only in their combined effects and increased the probability of UTI by 1.2–1.6 times (P < 0.05).
References
Kryuchko, T. O., Kuzmenko, N. V, Harshman, V. P., & Kozar, N. G. (2019). Retsydyvuiuchyi tsystyt u ditei: rezervy profilaktyky [Recurrent cysttitis in children: preventiv interventions]. Simeina medytsyna, (2), 43-48. [in Ukrainian].
Larcombe, J. (2015). Urinary tract infection in children: recurrent infections. BMJ clinical evidence, 2015, Article 0306.
Shaikh, N., Craig, J. C., Rovers, M. M., Da Dalt, L., Gardikis, S., Hoberman, A., Montini, G., Rodrigo, C., Taskinen, S., Tuerlinckx, D., & Shope, T. (2014). Identification of children and adolescents at risk for renal scarring after a first urinary tract infection: a meta-analysis with individual patient data. JAMA Pediatrics, 168(10), 893-900. https://doi.org/10.1001/jamapediatrics.2014.637
Shaikh, N., Mattoo, T. K., Keren, R., Ivanova, A., Cui, G., Moxey-Mims, M., Majd, M., Ziessman, H. A., & Hoberman, A. (2016). Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring. JAMA Pediatrics, 170(9), 848-854. https://doi.org/10.1001/jamapediatrics.2016.1181
National Institute for Health and Care Excellence. (2007, August 22). Urinary tract infection in under 16s: diagnosis and management. https://www.nice.org.uk/guidance/cg54/resources/urinary-tract-infection-in-under-16s-diagnosis-and-management-pdf-975507490501
European Association of Urology. (2018, March). EAU Guidelines on Urological Infections. https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urological-Infections-2018-large-text.pdf
Keren, R., Shaikh, N., Pohl, H., Gravens-Mueller, L., Ivanova, A., Zaoutis, L., Patel, M., deBerardinis, R., Parker, A., Bhatnagar, S., Haralam, M. A., Pope, M., Kearney, D., Sprague, B., Barrera, R., Viteri, B., Egigueron, M., Shah, N., & Hoberman, A. (2015). Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring. Pediatrics, 136(1), Article e13-e21. https://doi.org/10.1542/peds.2015-0409
Morello, W., La Scola, C., Alberici, I., & Montini, G. (2016). Acute pyelonephritis in children. Pediatrics Nephrology, 31(8), 1253-1265. https://doi.org/10.1007/s00467-015-3168-5
Okarska-Napierała, M., Wasilewska, A., & Kuchar, E. (2017). Urinary tract infection in children: Diagnosis, treatment, imaging - Comparison of current guidelines. Journal of pediatric urology, 13(6), 567-573. https://doi.org/10.1016/j.jpurol.2017.07.018
Fritzenwanker, M., Imirzalioglu, C., Chakraborty, T., & Wagenlehner, F. M. (2016). Modern diagnostic methods for urinary tract infections. Expert Review of Anti-infective Therapy, 14(11), 1047-1063. https://doi.org/10.1080/14787210.2016.1236685
Roupakias, S., Sinopidis, X., Tsikopoulos, G., Spyridakis, I., Karatza, A., & Varvarigou, A. (2017). Dimercaptosuccinic acid scan challenges in childhood urinary tract infection, vesicoureteral reflux and renal scarring investigation and management. Minerva Urologica e Nefrologica, 69(2), 144-152. https://doi.org/10.23736/S0393-2249.16.02509-1
Hewitt, I. K., Pennesi, M., Morello, W., Ronfani, L., & Montini, G. (2017). Antibiotic Prophylaxis for Urinary Tract Infection-Related Renal Scarring: A Systematic Review. Pediatrics, 139(5), Article e20163145. https://doi.org/10.1542/peds.2016-3145
American Urological Association. (2010). Management and Screening of Primary Vesicoureteral Reflux in Children (2010, amended 2017). https://www.auanet.org/guidelines/vesicoureteral-reflux-guideline
Mattoo, T. K., Chesney, R. W., Greenfield, S. P., Hoberman, A., Keren, R., Mathews, R., Gravens-Mueller, L., Ivanova, A., Carpenter, M. A., Moxey-Mims, M., Majd, M., Ziessman, H. A., & RIVUR Trial Investigators (2016). Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial. Clinical Journal of the American Society of Nephrology, 11(1), 54-61. https://doi.org/10.2215/CJN.05210515
Bland, M. (2015). An Introduction to Medical Statistics (4th ed.). Oxford University Press.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
