%0 Journal Article %J Acta Paediatr %D 2019 %T First urinary tract infections in children: the role of the risk factors proposed by the Italian recommendations. %A Alberici, I %A La Manna, A %A Pennesi, M %A Starc, M %A Scozzola, F %A Nicolini, G %A Toffolo, A %A Marra, G %A Chimenz, R %A Sica, F %A Maringhini, S %A Monasta, L %A Montini, G %X

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.

%B Acta Paediatr %V 108 %P 544-550 %8 2019 Mar %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/30028535?dopt=Abstract %R 10.1111/apa.14506