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Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux
PURPOSE: 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...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Yonsei University College of Medicine
2012
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3381488/ https://www.ncbi.nlm.nih.gov/pubmed/22665341 http://dx.doi.org/10.3349/ymj.2012.53.4.748 |
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author | Jang, Hyeon Chan Park, Yoo Jun Park, Jae Shin |
author_facet | Jang, Hyeon Chan Park, Yoo Jun Park, Jae Shin |
author_sort | Jang, Hyeon Chan |
collection | PubMed |
description | PURPOSE: 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. MATERIALS AND METHODS: 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)]. RESULTS: 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). CONCLUSION: 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. |
format | Online Article Text |
id | pubmed-3381488 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Yonsei University College of Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-33814882012-07-01 Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux Jang, Hyeon Chan Park, Yoo Jun Park, Jae Shin Yonsei Med J Original Article PURPOSE: 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. MATERIALS AND METHODS: 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)]. RESULTS: 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). CONCLUSION: 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. Yonsei University College of Medicine 2012-07-01 2012-05-22 /pmc/articles/PMC3381488/ /pubmed/22665341 http://dx.doi.org/10.3349/ymj.2012.53.4.748 Text en © Copyright: Yonsei University College of Medicine 2012 http://creativecommons.org/licenses/by-nc/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Jang, Hyeon Chan Park, Yoo Jun Park, Jae Shin Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux |
title | Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux |
title_full | Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux |
title_fullStr | Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux |
title_full_unstemmed | Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux |
title_short | Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux |
title_sort | predicting factors of breakthrough infection in children with primary vesicoureteral reflux |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3381488/ https://www.ncbi.nlm.nih.gov/pubmed/22665341 http://dx.doi.org/10.3349/ymj.2012.53.4.748 |
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