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Avoidance of voiding cystourethrography in infants younger than 3 months with Escherichia coli urinary tract infection and normal renal ultrasound
  1. Jean-Yves Pauchard1,
  2. Hassib Chehade2,
  3. Chafika Zohra Kies1,
  4. Eric Girardin3,
  5. Francois Cachat2,
  6. Mario Gehri1
  1. 1 Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
  2. 2 Department of Pediatrics, Pediatric nephrology unit, Lausanne University Hospital, Lausanne, Switzerland
  3. 3 Department of Pediatrics, Pediatric nephrology unit, Geneva University Hospital, Geneva, Switzerland
  1. Correspondence to Dr Hassib Chehade, Pediatric Nephrology Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; hassib.chehade{at}chuv.ch

Abstract

Background and objective Urinary tract infection (UTI) represents the most common bacterial infection in infants, and its prevalence increases with the presence of high-grade vesicoureteral reflux (VUR). However, voiding cystourethrography (VCUG) is invasive, and its indication in infants <3 months is not yet defined. This study aims to investigate, in infants aged 0–3 months, if the presence of Escherichia coli versus non-E. coli bacteria and/or normal or abnormal renal ultrasound (US) could avoid the use of VCUG.

Method One hundred and twenty-two infants with a first febrile UTI were enrolled. High-grade VUR was defined by the presence of VUR grade ≥III. The presence of high-grade VUR was recorded using VCUG, and correlated with the presence of E. coli/non-E. coli UTI and with the presence of normal/abnormal renal US. The Bayes theorem was used to calculate pretest and post-test probability.

Results The probability of high-grade VUR was 3% in the presence of urinary E. coli infection. Adding a normal renal US finding decreased this probability to 1%. However, in the presence of non-E. coli bacteria, the probability of high-grade VUR was 26%, and adding an abnormal US finding increased further this probability to 55%.

Conclusions In infants aged 0–3 months with a first febrile UTI, the presence of E. coli and normal renal US findings allow to safely avoid VCUG. Performing VCUG only in infants with UTI secondary to non-E. coli bacteria and/or abnormal US would save many unnecessary invasive procedures, limit radiation exposure, with a very low risk (<1%) of missing a high-grade VUR.

  • Non E. Coli bacteria
  • infant
  • renal ultrasound
  • urinary tract infection
  • vesicoureteral reflux
  • voiding cystourethrography.

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Footnotes

  • Contributors JYP, HC and MG: conceptualised and designed the study, participated in data analysis, drafted the initial manuscript and approved the final manuscript as submitted. CK and FC: participated in data analysis, participated in drafting the manuscript and approved the final manuscript as submitted. EG: participated in conceptualising, critically reviewed the manuscript and approved the final manuscript as submitted.

  • Competing interests None declared.

  • Patient consent This is a retrospective study and all data were retrieved through our coding system. Consent are obtained from parents.

  • Ethics approval The study was approved by the local ethic committee (number 74/14)

  • Provenance and peer review Not commissioned; externally peer reviewed.

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