@article {10780, title = {First urinary tract infections in children: the role of the risk factors proposed by the Italian recommendations.}, journal = {Acta Paediatr}, volume = {108}, year = {2019}, month = {2019 Mar}, pages = {544-550}, abstract = {

AIM: In 2009, the Italian society for paediatric nephrology suggested the need for cystography, following a first febrile urinary tract infection (UTI), only in children at high risk for dilating vesicoureteral reflux or in the event of a second infection. The aim of this study was to evaluate the adequacy of the risk factors proposed by the Italian guidelines.

METHODS: Children aged 2-36~months, managed by 10 Italian hospitals between 2009 and 2013, with a first febrile UTI were retrospectively evaluated.

RESULTS: Four hundred and fourteen children were included: 51\% female, mean age eight months. Escherichia coli was responsible of 84\% UTIs. 269 children (65\%) presented at least one risk factor, thus were further investigated: 44\% had a reflux. The presence of a pathogen other than E.~coli significantly predicted high-grade reflux, both in the univariate (Odd Ratio 2.52, 95\% Confidence Interval 1.32-4.81, p~<~0.005) and multivariate analysis (OR 2.74, 95\% CI: 1.39-5.41, p: 0.003). 26/145 children (18\%) with no risk factors experienced a second UTI, which prompted the execution of cystography, showing a dilating reflux in 11.

CONCLUSION: Among the risk factors proposed by the Italian guidelines, only the presence of a pathogen other than E.~coli significantly predicted reflux. Cystography can be postponed in children with no risk factors.

}, issn = {1651-2227}, doi = {10.1111/apa.14506}, author = {Alberici, I and La Manna, A and Pennesi, M and Starc, M and Scozzola, F and Nicolini, G and Toffolo, A and Marra, G and Chimenz, R and Sica, F and Maringhini, S and Monasta, L and Montini, G} }