Division of Urology, McMaster University, Hamilton, Ontario, Canada.
Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada.
J Urol. 2014 May;191(5 Suppl):1614-8. doi: 10.1016/j.juro.2013.10.035. Epub 2014 Mar 26.
We assessed risk factors for urinary tract infection in children with prenatal hydronephrosis
We identified 376 infants with prenatal hydronephrosis in an institutional database. The occurrence of febrile urinary tract infection in the first 2 years of life was ascertained by chart review. Febrile urinary tract infection was defined as a positive culture from a catheterized urine specimen in a patient with a fever of 38.0C or greater. Multivariate logistic regression was used to assess gender, circumcision status, hydronephrosis grade, vesicoureteral reflux grade and antibiotic prophylaxis as predictors of the risk of urinary tract infection.
Included in analysis were 277 males and 99 females. Hydronephrosis was high grade in 128 infants (34.0%) and vesicoureteral reflux was present in 79 (21.0%). Antibiotic prophylaxis was prescribed in 60.4% of patients, preferentially to females vs males (70.7% vs 56.7%), those with high vs low grade hydronephrosis (70.3% vs 55.2%) and those with vs without vesicoureteral reflux (96.2% vs 50.8%). On multivariate analysis there was an association between high grade hydronephrosis and an increased risk of urinary tract infection (adjusted OR 2.40, 95% CI 1.26-4.56). Females (adjusted OR 3.16, 95% CI 0.98-10.19) and uncircumcised males (adjusted OR 3.63, 95% CI 1.18-11.22) were also at higher risk than circumcised males. Antibiotic prophylaxis was not associated with a decreased risk of urinary tract infection (adjusted OR 0.93, 95% CI 0.45-1.94).
High grade hydronephrosis, female gender and uncircumcised status in males are independent risk factors for febrile urinary tract infection in infants with prenatal hydronephrosis. Antibiotic prophylaxis did not reduce the risk of urinary tract infection in the study group.
我们评估了产前肾积水患儿尿路感染的危险因素。
我们在一个机构数据库中确定了 376 名患有产前肾积水的婴儿。通过病历回顾确定了 2 年内发热性尿路感染的发生情况。发热性尿路感染定义为发热患者（体温≥38.0°C）的导管尿液标本中存在阳性培养物。多变量逻辑回归用于评估性别、割礼状态、肾积水分级、输尿管反流分级和抗生素预防作为尿路感染风险的预测因素。
分析包括 277 名男性和 99 名女性。128 名婴儿（34.0%）存在重度肾积水，79 名（21.0%）存在输尿管反流。60.4%的患者接受了抗生素预防治疗，女性比男性更倾向于接受治疗（70.7%比 56.7%），肾积水程度较高的患者比程度较低的患者更倾向于接受治疗（70.3%比 55.2%），存在输尿管反流的患者比不存在输尿管反流的患者更倾向于接受治疗（96.2%比 50.8%）。多变量分析显示，重度肾积水与尿路感染风险增加相关（调整后的 OR 2.40，95%CI 1.26-4.56）。女性（调整后的 OR 3.16，95%CI 0.98-10.19）和未割礼的男性（调整后的 OR 3.63，95%CI 1.18-11.22）比割礼的男性风险更高。抗生素预防治疗与尿路感染风险降低无关（调整后的 OR 0.93，95%CI 0.45-1.94）。
重度肾积水、女性和男性未割礼状态是产前肾积水患儿发热性尿路感染的独立危险因素。在研究组中，抗生素预防治疗并未降低尿路感染的风险。
