Treatment of Occult Reflux Lowers the Incidence Rate of Pediatric Febrile Urinary Tract Infection

Jennifer Hagerty*, Max Maizels, Andrew Kirsch, Dennis Liu, Kourosh Afshar, Timothy Bukowski, Paolo Caione, Yves Homsy, Theresa Meyer, William Kaplan

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)72-76
Number of pages5
JournalUrology
Volume72
Issue number1
DOIs
StatePublished - Jul 1 2008

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Urinary Tract Infections
Fever
Pediatrics
Incidence
Therapeutics
Confidence Intervals
Replantation
Registries
Parents
Observation
Prospective Studies
Anti-Bacterial Agents
Injections

ASJC Scopus subject areas

  • Urology

Cite this

Hagerty, Jennifer ; Maizels, Max ; Kirsch, Andrew ; Liu, Dennis ; Afshar, Kourosh ; Bukowski, Timothy ; Caione, Paolo ; Homsy, Yves ; Meyer, Theresa ; Kaplan, William. / Treatment of Occult Reflux Lowers the Incidence Rate of Pediatric Febrile Urinary Tract Infection. In: Urology. 2008 ; Vol. 72, No. 1. pp. 72-76.
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title = "Treatment of Occult Reflux Lowers the Incidence Rate of Pediatric Febrile Urinary Tract Infection",
abstract = "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.",
author = "Jennifer Hagerty and Max Maizels and Andrew Kirsch and Dennis Liu and Kourosh Afshar and Timothy Bukowski and Paolo Caione and Yves Homsy and Theresa Meyer and William Kaplan",
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Hagerty, J, Maizels, M, Kirsch, A, Liu, D, Afshar, K, Bukowski, T, Caione, P, Homsy, Y, Meyer, T & Kaplan, W 2008, 'Treatment of Occult Reflux Lowers the Incidence Rate of Pediatric Febrile Urinary Tract Infection', Urology, vol. 72, no. 1, pp. 72-76. https://doi.org/10.1016/j.urology.2008.02.004

Treatment of Occult Reflux Lowers the Incidence Rate of Pediatric Febrile Urinary Tract Infection. / Hagerty, Jennifer; Maizels, Max; Kirsch, Andrew; Liu, Dennis; Afshar, Kourosh; Bukowski, Timothy; Caione, Paolo; Homsy, Yves; Meyer, Theresa; Kaplan, William.

In: Urology, Vol. 72, No. 1, 01.07.2008, p. 72-76.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment of Occult Reflux Lowers the Incidence Rate of Pediatric Febrile Urinary Tract Infection

AU - Hagerty, Jennifer

AU - Maizels, Max

AU - Kirsch, Andrew

AU - Liu, Dennis

AU - Afshar, Kourosh

AU - Bukowski, Timothy

AU - Caione, Paolo

AU - Homsy, Yves

AU - Meyer, Theresa

AU - Kaplan, William

PY - 2008/7/1

Y1 - 2008/7/1

N2 - 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.

AB - 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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