Swedish Reflux Trial in Children - Pattern of Urinary Tract Infections

• PURPOSE To evaluate the difference in rate of febrile urinary tract infection in small children with dilating vesicoureteral reflux, randomly allocated to 3 management alternatives: antibiotic prophylaxis, endoscopic treament, or surveillance only (control group). MATERIAL AND METHODS From 23 centers, a total of 203 children were included, 128 girls and 75 boys aged 1 to less than 2 years. Vesicoureteral reflux grade III (n=126) or IV (n=77) was detected after a febrile urinary tract infection in 194 and after antenatal screening in 9. Voiding cystourethrography and dimercaptosuccinic acid scintigraphy were performed before randomization and after 2 years. The rate of symptomatic febrile urinary tract infections was analyzed according to the intention-to-treat principle. RESULTS There were 67 febrile recurrences in 42 girls and 8 recurrences in 7 boys (p=0.0001). There was a difference in recurrence rate between the treatment groups in girls, were febrile infection was seen in 8 of 43 (19%) girls in the prophylaxis, 10 of 43 (23%) in the endoscopic, and 24 of 42 (57%) in the surveillance group (p=0.0002). In girls there was no difference in recurrence rate between those with grade III and IV reflux at entry, but recurrence was associated with reflux grade at follow-up (p=0.0095). CONCLUSIONS In this randomized controlled trial there was a high rate of recurrent febrile urinary tract infections in girls over the age of 1 year with dilating vesicoureteral reflux, but not in boys. Both antibiotic prophylaxis and endoscopic treatment reduced the rate of infections.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Pediatrik (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Pediatrics (hsv//eng)

Keyword

Vesikoureteral reflux

njurskada

urinvägsinfektion

Publication and Content Type

vet (subject category)

kon (subject category)