Treatment of occult reflux lowers the incidence rate of pediatric febrile urinary tract infection.
Hagerty J, Maizels M, Kirsch A, Liu D, Afshar K, Bukowski T, Caione P, Homsy Y, Meyer T, Kaplan W; PIC Cystography Group.Collaborators (34)Afshar K, Alpert S, Chaviano A, Cheng E, Austin C, Bukowski T, Caione P, Cooper C, Dean G, Gatti J, Hagerty J, Hanna MK, Homsy Y, Kaplan W, Kirsch A, Kolligian M, Kramer SA, Kropp K, Lashley D, Liu D, Maizels M, Mesrobian H, Meyer T, McMahon D, Nasarallah P, Packer M, Pinto K, Pugach J, Reinberg Y, Routh J, Vandersteen D, Wolpert JJ, Yerkes E, Zaontz M.
Children's Memorial Hospital, Chicago, Illinois 60611, USA. jhagerty@childrensmemorial.org
OBJECTIVES: To examine whether vesicourethral reflux diagnosed by positioned instillation of contrast (PIC-VUR) shows clinical importance by comparing the incidence rates of febrile urinary tract infection (FUTI) before and after treatment of PIC-VUR. METHODS: Beginning in 2001 we used a multi-institutional registry to prospectively enroll consecutive pediatric patients with a history of FUTI without VUR according to voiding cystourethrogram (VCUG) and yet who show PIC-VUR. Treatment of PIC-VUR was with prophylactic antimicrobials or antireflux surgery. The post-treatment occurrence of FUTI was tracked. RESULTS: A total of 14 centers enrolled 118 patients (mean age, 7.2 years; range, 0.5 to 20 years). Parents self-selected the treatment of PIC-VUR as endoscopic injection (104), ureteral reimplantation (3), or antimicrobial prophylaxis (11). Study intervals surveying for FUTI before PIC (mean, 12 months; range, 1 to 17 years) and after PIC treatment (mean, 11 months; range, 0 to 3 years) were not significantly different. Overall the incidence rate for FUTI decreased significantly from 0.16 per patient per month before PIC-VUR treatment to 0.008 per patient per month after treatment (rate ratio 20; 95% confidence interval 11 to 36). The post-treatment rate of FUTI in patients treated with antibiotics versus surgery was not significantly different (rate ratio 2.5; 95% confidence interval 0.33 to 27). CONCLUSIONS: The diagnosis of PIC-VUR is clinically important because children treated for PIC-VUR with either antimicrobial prophylaxis or surgery show a significant reduction in the incidence rate of FUTI. This is the basis for a current prospective study randomizing patients with PIC-VUR to treatment or observation.
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PMID: 18407331 [PubMed - indexed for MEDLINE]