Prevention of recurrent febrile urinary tract infection in infants: Ultrasonography-oriented approach is more practical than a top-down approach.

Abstract

BACKGROUND:

We previously reported that the top-down approach (TDA) for infants with febrile urinary tract infections (fUTI) could prevent recurrent fUTI (r-fUTI) but produced a high number of false-positives on acute-phase 99m Tc dimercaptosuccinic acid (DMSA) renal scintigraphy. Therefore we compared the ultrasonography-oriented approach (USOA) with TDA from the viewpoint of prevention of r-fUTI.

METHODS:

The TDA was applied between July 2010 and February 2014 and the USOA was applied between March 2014 and April 2017 in infants with first fUTI. In the USOA group, voiding cystourethrography (VCUG) was performed in the case of abnormality on acute-phase renal bladder ultrasonography (RBUS) or on chronic- phase DMSA, which were performed in all cases. The frequency of r-fUTI was compared between the TDA group and USOA group retrospectively.

RESULTS:

Seventy-four infants (52 male) and 79 infants (60 male) received TDA or USOA, respectively. No significant differences were found between the TDA and USOA groups in male : female ratio, age in months at initial onset of fUTI, observation period, or number of cases of r-fUTI (TDA group, n = 4; USOA group, n = 5). Seventy-four DMSA scintigraphy and 25 VCUG were carried out in the USOA group, and 111 DMSA scintigraphy and 34 VCUG in the TDA group.

CONCLUSIONS:

Both USOA and TDA were valid for prevention of r-fUTI, but USOA was superior to TDA with regard to the reduced number of patients undergoing VCUG and DMSA.

• Authors: Shina Kawai, Hideo Nakai, Takahiro Kanai, Kazuya Tanabe, Taiju Hyuga, Shigeru Nakamura, Hiroyuki Betsui, Jun Aoyagi, Takashi Saito, Takane Ito, Jun Odaka, Rieko Furukawa, Toshinori Aihara
• Journal: Pediatrics international : official journal of the Japan Pediatric Society (Pediatr Int) Vol. 61 Issue 10 Pg. 1007-1014 (Oct 2019) ISSN: 1442-200X [Electronic] Australia
• PMID: 31298773 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2019 Japan Pediatric Society.

Chemical References

• Radiopharmaceuticals
• Technetium Tc 99m Dimercaptosuccinic Acid

Topics

• False Positive Reactions
• Female
• Fever (etiology)
• Follow-Up Studies
• Humans
• Infant
• Male
• Radionuclide Imaging
• Radiopharmaceuticals
• Recurrence
• Retrospective Studies
• Secondary Prevention (methods)
• Technetium Tc 99m Dimercaptosuccinic Acid
• Ultrasonography
• Urinary Tract Infections (complications, diagnostic imaging, prevention & control)