Pediatric Nephrourology Unit, School of Medicine, Brazilian National Research Council (CNPq), Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Pediatr Infect Dis J. 2010 Feb;29(2):139-44. doi: 10.1097/inf.0b013e3181b8e85f.
Knowledge of risk of urinary tract infection (UTI) recurrence in vesicoureteral reflux (VUR) can help clinicians make therapeutic decisions. The aim of this retrospective cohort study was to identify risk factors associated with recurrent urinary tract infection in children with VUR. In addition, a risk score that might predict the chance of UTI recurrence was also proposed.
Between 1970 and 2007, 740 patients were diagnosed with VUR and were systematically followed up at a single tertiary Renal Unit. Recurrent UTI was defined as more than 1 episode during follow-up. A binary logistic regression model was applied to identify variables independently associated with recurrent UTIs.
During follow-up, information was obtained on 58,856 person-months. Recurrent UTIs occurred in 120 (16.2%) patients. The overall incidence rate of UTI was 8.4 episodes per 1000 person-months (95% CI, 7.7, 9.2). After adjustment by multivariable analysis, 5 variables were independent predictors of recurrent UTI: UTI as clinical presentation, age < 6 months, female gender, dysfunctional elimination syndrome, and severe grade of reflux. The risk for recurrent UTI was classified as low in 24% of children, medium in 42%, and high in 34%. UTI incidence rates per 1000 person-months were 4.3 (95% CI, 3.2, 5.6), 7.9 (95% CI, 6.7, 9.1), and 11.3 (95% CI, 9.9, 12.8) for low-, medium-, and high-risk groups, respectively.
The prediction model of recurrent UTI allows an early recognition of patients at risk for long-term morbidity and might contribute to the formulation of therapeutic strategies.
了解复发性尿路感染 (UTI) 在膀胱输尿管反流 (VUR) 中的风险有助于临床医生做出治疗决策。本回顾性队列研究的目的是确定与 VUR 患儿复发性尿路感染相关的危险因素。此外，还提出了一种可能预测 UTI 复发机会的风险评分。
1970 年至 2007 年间，740 例患者被诊断为 VUR，并在单一三级肾脏科接受系统随访。复发性 UTI 定义为随访期间发生超过 1 次感染。应用二项逻辑回归模型确定与复发性 UTIs 独立相关的变量。
随访期间，共获得 58856 人月的信息。120 例（16.2%）患者发生复发性 UTI。UTI 的总体发生率为每 1000 人月 8.4 例（95%CI，7.7，9.2）。多变量分析调整后，5 个变量是复发性 UTI 的独立预测因素：以 UTI 为临床表现、年龄<6 个月、女性、功能性排泌障碍和严重反流程度。复发性 UTI 的风险分为低危（24%）、中危（42%）和高危（34%）。低危、中危和高危组的 UTI 发生率分别为每 1000 人月 4.3（95%CI，3.2，5.6）、7.9（95%CI，6.7，9.1）和 11.3（95%CI，9.9，12.8）。
复发性 UTI 的预测模型可早期识别出长期发病风险较高的患者，并有助于制定治疗策略。
