Article Text

Download PDFPDF
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}


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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • 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.

Linked Articles