Department of Urology, Catholic University of Daegu, School of Medicine, Daegu, Korea.
Yonsei Med J. 2012 Jul 1;53(4):748-52. doi: 10.3349/ymj.2012.53.4.748.
Many pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses.
We retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)].
Breakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0±8.2 months) than in boys (5.8±4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean±SD age at diagnosis of VUR in patients with breakthrough infection (1.14±3.14) was significantly younger than in those without breakthrough infection (5.05±3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028).
Our data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.
许多小儿泌尿科医生仍倾向于使用预防性抗生素治疗膀胱输尿管反流（VUR）患儿。然而，有时会发生突破性感染，导致发病率显著增加，进而导致肾瘢痕形成。因此，我们通过单因素分析来测试异常肾脏扫描和其他因素是否可预测突破性感染。
我们回顾性分析了 1997 年 11 月至 2010 年 6 月期间连续诊断为膀胱输尿管反流的 163 例儿童的病历。用于统计分析的临床参数包括表现形式、性别、年龄、VUR 分级、侧别、肾内反流的存在、抗生素药物类别以及二巯丁二酸的异常肾脏扫描。通过单因素分析确定用于预后因素的临床参数。使用 SPSS 软件（SPSS ver. 12.0 [SPSS Inc.，芝加哥，IL，美国]）进行 Fisher 确切检验和未配对 t 检验。
61 例（48.0%）患儿发生突破性感染。共有 58 例（45.7%）患儿的肾脏扫描异常。发生突破性感染的时间在女孩（9.0±8.2 个月）明显长于男孩（5.8±4.8 个月，p<0.05）。虽然在单因素分析中没有统计学意义，但异常肾脏扫描是突破性感染的最具预测性因素（p=0.062）。在肾脏扫描异常的患者中，突破性感染与表现形式、性别、分级或预防性抗生素无关。然而，在年龄小于 1 岁和年龄大于或等于 1 岁的患者之间存在显著差异。发生突破性感染的 VUR 诊断时的平均年龄（1.14±3.14）显著小于未发生突破性感染的患者（5.05±3.31，p=0.009）。在双侧或单侧反流患者之间也存在显著差异（p=0.028）。
我们的数据表明，异常肾脏扫描是突破性感染的最具预测性因素，在 1 岁以下患者中具有统计学意义。家长和医生应始终意识到，这些患者发生突破性尿路感染的风险较高，可能导致肾脏损伤。
