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PubMed2001

Antibiotic failure in the treatment of urinary tract infections in young women.

Urinary tract infections (UTIs) are a common problem in young women. The aim of this study was to describe the pattern of antibiotic prescribing to young women presenting with new UTIs and to investigate the proportion who required further treatment if prescribed antibiotics. A secondary aim was to investigate whether the likelihood of treatment failure varied between different antibiotics and, in the case of trimethoprim (the antibiotic most frequently prescribed for UTIs) between prescriptions of different duration. The study included all women aged 15-44 years registered on the UK General Practice Research Database. All diagnoses of UTI or cystitis with an associated prescription for an antibiotic were identified. A further prescription of an antibiotic within 28 days was taken to indicate failure of the initial treatment. Overall, 14% of 75045 newly treated patients with UTI received a second antibiotic within 28 days. Older women, aged 35-44, pregnant patients and those with diabetes were significantly more likely to require further treatment. With trimethoprim as the reference antibiotic, after 28 days patients prescribed amoxicillin were significantly more likely to require a second course of antibiotics. Those prescribed co-trimoxazole were significantly less likely to require further treatment. In each case the difference in failure rate was small and may be of little clinical significance. There was no significant difference between trimethoprim and nitrofurantoin, norfloxacin, ciprofloxacin or the cephalosporins. Three-day prescriptions for trimethoprim appeared as effective as those for 5 or 7 days. This study gives some observational evidence of the effectiveness of antibiotic prescribing in young women with UTIs and shows that between 12% and 16% of patients will return within 28 days for further treatment, irrespective of the antibiotic prescribed initially.

Adolescent↗
PubMed2002

Exposure to co-amoxiclav as a risk factor for co-amoxiclav-resistant Escherichia coli urinary tract infection.

The objective of the study was to define whether individual exposure to co-amoxiclav is a risk factor for selecting co-amoxiclav-resistant Escherichia coli in vivo. One hundred and eight patients were included in our study as soon as they were found to have a urinary tract infection (UTI) due to E. coli. Stool probes were also undertaken for some of these patients. Co-amoxiclav administration in the month before diagnosing the UTI, and any treatment to cure the current UTI were recorded for all patients. When co-amoxiclav-resistant E. coli was detected in the stools after diagnosis of E. coli UTI, isolates were compared with urinary E. coli isolates in terms of clonal relatedness, beta-lactam susceptibility and mechanisms of beta-lactam resistance. The patients who had taken co-amoxiclav in the month before the reported E. coli UTI had a significantly higher risk of being infected with co-amoxiclav-resistant E. coli. Those patients treated with amoxicillin for a current infection were at greater risk of intestinal carriage of co-amoxiclav-resistant E. coli; those treated with co-amoxiclav had a greater risk of intestinal carriage of co-amoxiclav-resistant Gram-negative bacilli than patients treated with third-generation cephalosporins or fluoroquinolones. Hence, individual exposure to co-amoxiclav is a risk factor for UTIs caused by co-amoxiclav-resistant E. coli or for carrying co-amoxiclav-resistant Gram-negative bacilli in the digestive tract.

Aged↗
PubMed1997

Infectious disease complications of simultaneous pancreas kidney transplantation.

BACKGROUND: Although technical success rate of simultaneous pancreas kidney (SPK) transplantation in insulin-dependent diabetes mellitus (IDDM) patients with diabetic nephropathy has improved, morbidity remains high due to infection and rejection. The purpose of this study was to analyse infections encountered in our series of SPK transplants, using a restrictive antibiotic prophylaxis policy. METHODS: We reviewed all infectious diseases after 66 consecutive bladder-drained SPK transplantations in 64 IDDM patients with end-stage renal disease due to diabetic nephropathy. During follow-up, the perioperative antibiotic regimen was altered (from 5 days preemptive therapy with multiple drugs to 1 day prophylaxis with cefamandole), and long-term viral prophylaxis (high-dose aciclovir) was introduced. For post-operative urinary tract or opportunistic infection, no prophylaxis was given. RESULTS: Overall mean infection rate was 2.9 infections/ patient/year after a mean follow-up of 2.3 years. Surgical site infections (SSI) were seen in 30% of the patients, with Enterococci present in 47%. Logistic regression showed one day cefamandole prophylaxis to be associated with SSI, but there was no significant influence of SSI on either graft or patient survival. Forty-eight percent of all infections were lower urinary tract infections (UTI). There were 59 first UTIs (89%), probably related to long-term Foley catheter use, and 47 second UTIs (71%). Subsequent UTIs were not microbiologically related to first UTIs. Cytomegalovirus (10 patients) and other opportunistic agents did not cause mortality or graft loss. Five grafts were lost due to infection (SSI three times, post-transplant lymphoproliferative disease twice). Only one patient died because of infection (2%). CONCLUSIONS: Infectious diseases after SPK transplantation caused significant morbidity but did not influence either patient or graft survival. A change in prophylactic policy for both SSI as well as recurrent UTI, combined with earlier Foley removal, may lower incidences of these infections.

Adult↗
PubMed1997

Urinary tract infection: an overview.

Urinary tract infection (UTI) remains very common. As many as 50% of women report having had at least one UTI in their lifetimes. Urinary tract infection is the most common cause of infection in nursing home residents and the most common source of bacteremia in the elderly population. Urinary tract infection occurs in patients with structurally or functionally abnormal urinary tracts (complicated UTI) and in patients with anatomically normal urinary tracts (uncomplicated UTI). Escherichia coli (E coli) is the most common cause of uncomplicated UTI, whereas antibiotic-resistant Enterobacteriaceae, enterococci, and Candida species often are the causes of complicated UTI. In this article we review current concepts of the epidemiology, microbiology, pathophysiology, clinical manifestations, diagnosis, and treatment of urinary tract infection.

Anti-Bacterial Agents↗
PubMed1991

Uropathogens of various childhood populations and their antibiotic susceptibility.

To define the uropathogens of various childhood populations and their antibiotic susceptibility, 646 episodes of urinary tract infections (UTI) were studied. Of the community-acquired UTI 78% were caused by Escherichia coli and 12% by Klebsiella whereas only 65% of hospital-acquired UTI were caused by E. coli (P less than 0.01), and other pathogens, including Pseudomonas, were more common. In children with UTI who did not have an underlying disorder, most infections were caused by E. coli and Klebsiella species. Children with urinary malformations or urinary catheters or those who developed UTI while receiving antibiotic prophylaxis had fewer E. coli infections and more infections caused by other pathogens, including Pseudomonas (P less than 0.01). Children receiving antibiotic prophylaxis had also significantly more Enterococcus and Acinetobacter infections (P less than 0.001), and children with urinary catheters had more Enterobacter infections (P less than 0.05). Isolates of these risk groups showed increased resistance to antibiotics. Only 30-53% were susceptible to trimethoprim-sulfamethoxazole, which is usually recommended for UTI; 19 to 25% and 27 to 66% were susceptible to ampicillin and cephalothin, respectively. In contrast uropathogens of immunocompromised children did not differ significantly from those of children with no underlying disturbances, nor did they show distinct antibiotic susceptibility patterns.

Adolescent↗
PubMed1994

Urinary N-acetyl-beta-glucosaminidase and beta-2-microglobulin in the diagnosis of urinary tract infection in febrile infants.

Urinary N-acetyl-beta-glucosaminidase (NAG) and beta-2-microglobulin (B2M) concentrations were measured in 24 pediatric patients with febrile urinary tract infection (UTI) and compared with the technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan results, in order to evaluate a noninvasive means to localize the site of UTI. Increased urinary B2M and NAG were not associated with renal inflammation (pyelonephritis), as defined by positive dimercaptosuccinic acid scan. Median NAG concentrations were 114.2 mumol/hour/mg creatinine (CR) (range, 5.7 to 305.4) in 17 febrile UTI patients vs. 13.8 (range, 3.4 to 104.3) in 17 age and sex-matched febrile controls with negative urine cultures, P = 0.0001. The sensitivity and specificity of NAG > or = 40 mumol/hour/mg of CR in predicting UTI in febrile patients, regardless of the site of infection, were 88 and 88%, respectively. Increased urinary NAG is associated with UTI in febrile patients regardless of the level of infection (scan status), and may be an informative indicator of UTI.

Acetylglucosaminidase↗
PubMed2001

Sterile cerebrospinal fluid pleocytosis in young infants with urinary tract infection.

BACKGROUND: During the first 3 months of life febrile infants are subjected to sepsis workup, which includes evaluation for urinary tract infection (UTI) and meningitis. We investigated the existence of concomitant meningeal inflammation in infants younger than 90 days old affected with UTI. METHODS: We reviewed the medical records of all infants younger than 90 days old, who were hospitalized for UTI from January, 1990, to January, 2001. For the diagnosis of sterile cerebrospinal fluid (CSF) pleocytosis, the child's age, the CSF total white blood cell (WBC) count and the CSF absolute neutrophil count were taken into consideration. CSF pleocytosis was defined as the presence of > or = 35, > or = 21 and > or = 15 WBC/mm3 of CSF during the first, second and third month of life, respectively. The CSF Gram-stained smear, latex agglutination test and bacterial culture were negative. RESULTS: Sterile CSF pleocytosis was found in 15 (12.8%) of 117 infants with UTI who had had a lumbar puncture included in their initial laboratory evaluation. The 15 infants had a median age +/- semiinterquartile range of 40 +/- 25 days (range, 4 to 75 days). In these infants the median CSF WBC count +/- semiinterquartile range was 55 +/- 125/mm3 (range, 21 to 1,270/mm3). CONCLUSIONS: Sterile CSF pleocytosis was found in 12.8% of infants younger than 90 days old with UTI. The pathogenesis of this meningeal inflammation is not fully understood. Although bacterial infection of the subarachnoid space, with low bacterial seeding, cannot be excluded, at least in some cases, it is possible that CSF pleocytosis in some of the infants with UTI is mainly caused by the endotoxin of Gram-negative or other inflammation-inducing molecules of Gram-positive urine pathogens.

Greece↗
PubMed1993

The effect of protease inhibitor on reperfusion injury after unilateral pulmonary ischemia.

Reperfusion injury is a large problem in the early stage after lung transplantation. Its prevention by protease inhibitor was evaluated experimentally. Warm ischemic models were made with the left lungs of adult mongrel dogs. The time for the warm ischemic procedure was set at 2 hr, and the lungs were reperfused for 2 hr. The experimental group was divided into a control group, a UTI (urinary trypsin inhibitor) group and a GM (gabexate mecilate) group. To the UTI group, 10,000 units/kg of UTI was administrated during reperfusion, and to the GM group, 20 mg/kg of gabexate mecilate was administrated similarly. In the control group, the pulmonary vascular resistance and the lung tissue wet and dry weight ratios (W/D ratios) increased significantly, and thickened interstitium and infiltration of neutrophils were observed histologically after reperfusion. In the GM group, W/D ratios increased significantly, and histological appearances were similar to the control group. In the UTI group, the pulmonary vascular resistance increased slightly, but the W/D ratio did not increase significantly, and no changes were seen histologically after reperfusion. In the survival experiment, only two of the five dogs survived for more than seven days in the control and GM groups, while all five dogs survived for more than seven days in the UTI group. These results indicate that UTI significantly attenuates reperfusion injury, perhaps by inhibiting neutrophil proteases.

Animals↗
PubMed2002

Validity of urinalysis and microscopy for detecting urinary tract infection in the emergency department.

This study assessed the validity of standard urinalysis, urinalysis for leucocyte esterase and nitrites, and urgent microscopy in the diagnosis of urinary tract infection (UTI) in 60 female patients with a triage diagnosis of UTI. There were 24 (40%) proven UTIs after culture. Simple urinalysis was sensitive for UTI (95.8%) but the positive predictive value was only 45.1%. The addition of leucocyte esterase and nitrite urinalysis testing did not improve the sensitivity, but if both of these were positive the positive predictive value improved to 100%. Urgent microscopy alone was sensitive (100%) but non-specific (38.9%). The specificity of the diagnosis improved to 94.4% for organism counts of >or=10/microl and to 88.9% for leucocyte counts of >or=50/microl. The negative predictive value of no detectable leucocytes on microscopy was 94.7%. Screening for UTI in the emergency department (ED) population is improved by the addition of leucocyte esterase and nitrite test. A positive urinalysis test for leucocytes and nitrites, or urinalysis positive at levels of >or=500 leucocytes or >or=5 g/l protein should confirm a clinical diagnosis of UTI. Urgent urine microscopy should be performed only if the above criteria are not met yet a minimum of one urinalysis result is positive.

Adult↗
PubMed2003

Pediatric urinary tract infections: the role of fluoroquinolones.

Infections of the urinary tract (UTI) occur commonly in the pediatric population. Because of the high association of pediatric UTI with congenital structural anomalies of the urinary tract and with dysfunctional elimination syndromes, it is far more common for children to be categorized as having complicated UTI than their adult counterparts. And for children more intensive therapy is often required. Early and effective treatment of UTIs in the pediatric patient is considered essential to prevent long term morbidity and potential mortality from end stage renal disease. An oral antimicrobial is more convenient than parenteral therapy and is preferable as long as clinical efficacy and safety can be assured. Oral fluoroquinolones are an attractive alternative for the treatment of complicated UTI in children, and safety must always be a factor in considering their use in this population. Although the role of fluoroquinolones in pediatric UTI is still under investigation, the limited data available demonstrate a likelihood of efficacy and safety.

Age Factors↗
PubMed2004

Residual urine in an elderly female population: novel implications for oral estrogen replacement and impact on recurrent urinary tract infection.

PURPOSE: While the distribution of post-void residual urine volume (PVR) has been well studied in men, scant literature is available concerning PVR in women. We characterized any relationship between PVR and urinary tract infection (UTI). We also characterized other factors that could impact bladder emptying, including oral estrogen replacement therapy. MATERIALS AND METHODS: Inclusion criteria were at least 2 clinic visits and no antimicrobial prophylaxis in the last year. Women with a history of diabetes or cystocele were excluded. In a 17-month period 204 women met inclusion criteria. PVR was measured by catheterized specimen. Patients were categorized into groups by UTI history, namely 94 of those with no UTIs in the last year (group 1) and 110 with 1 or more documented UTIs in the last year (group 2). Factors that could affect bladder emptying were tested for the impact on PVR. RESULTS: Mean PVR in the study group was 53.13 ml. The mean PVR in groups 1 and 2 was 33 and 70.25 ml, respectively. The difference between these 2 groups was significant (p <0.0001). Estrogen status data were available on 186 patients. The 62 patients on estrogen replacement therapy had a mean PVR of 39.33 ml. The 124 patients not on estrogen replacement therapy had a mean PVR of 66.67 ml. The difference between these 2 groups was significant (p = 0.002) and independent of UTI history. CONCLUSIONS: Of elderly women those with high PVR were more likely to have recurrent UTIs. Improved bladder function was documented in women receiving oral estrogen replacement therapy.

Age Factors↗
PubMed2006

Racial and ethnic differences in the rates of urinary tract infections in febrile infants in the emergency department.

OBJECTIVE: To characterize the racial and ethnic differences in rates of urinary tract infections among febrile infants who present to an urban pediatric emergency department. METHODS: A retrospective chart review was conducted using the medical records of an urban pediatric emergency department from the period between 5/2002 and 1/2003. Data were collected from infants aged 1 to 24 months from whom urine cultures were obtained as part of their fever workup. Demographic data were recorded as provided by the parents or caregivers of the patients. Urine culture results were also recorded. RESULTS: Four hundred and sixty five children had urine cultures performed during the study period and fulfilled the inclusion criteria. Parents characterized the children as white (45%), Hispanic (27%), African American (20%), Asian (3.9%), or others (4.3%). Clinical parameters including the height of fever, age of the patient, and proportion of men were similar between the subjects in each racial and ethnic group. Sixty-four children were diagnosed as having UTI. The overall prevalence of UTI was 14% (95% confidence interval [CI] 11%-17%). Rates of UTI (SD) were as follows: Asian 22% (10%), white 16% (2.4%), Hispanic 16% (3.1%), African American 4.0% (1.9%), and Others 11 % (6.2%). African American infants had a lower rate of UTI (p = 0.007) compared with the general population. The odds ratio (OR) of UTI in white versus African American children and Hispanic versus African American children were 4.4 (95% CI, 1.5 to 12.6) and 4.6 (95% CI, 1.5 to 13.9), respectively. These results were consistent after adjustment for sex. CONCLUSIONS: Urinary tract infections were common in our study population of racially and ethnically diverse children. Given similar clinical parameters, white and Hispanic children were much more likely to be diagnosed with UTI than African-American children.

Black or African American↗
PubMed2003

Urinary trypsin inhibitor improves peripheral microcirculation and bronchospasm associated with systemic anaphylaxis in rabbits in vivo.

Using intravital microscopy of the rabbit ear for quantitative studies of microvascular dynamics, we examined the impact of urinary trypsin inhibitor (UTI), a proteolytic enzyme inhibitor, on microvascular changes during immune complex-mediated anaphylaxis. A total of 50 rabbits, previously sensitized with horse serum, were anesthetized and mechanically ventilated with pentobarbital and isoflurane for the intravital microscopy. Rabbits were then challenged with intravenous injection of horse serum to induce systemic anaphylaxis. One minute after the challenge, each rabbit was randomly assigned to receive saline (group C), 50,000 units x kg(-1) of UTI (group U1), or 150,000 units x kg(-1) (group U2). There were no statistical differences between hemodynamic variables, including heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP), among the survivors in each treatment group. Peak inspiratory pressure rose in all three groups but at a much higher rate in group C (P < 0.05). In contrast with the moderate effects of UTI on the above parameters, microscopic evaluation revealed a substantial difference among treatment groups: upon the initiation of anaphylaxis, the arteriole started to reduce in diameter, but UTI prevented vasoconstriction in the arteriole in a dose-dependent manner. Similar results were observed with blood flow velocity. Because flow rate was calculated as the product of blood flow velocity and vascular cross-sectional area proportional to the square of the vessel diameter, these results indicate that UTI preserves microvascular flow rate during anaphylaxis. Rabbit ear microcirculation is highly preserved in the UTI-treated groups during systemic anaphylactic shock.

Anaphylaxis↗
PubMed1997

Improving the prescribing of antibiotics for urinary tract infection.

BACKGROUND: In recent years there have been changes in the recommended antibiotic treatment for urinary tract infections (UTIs). In particular, the use of amoxycillin or co-trimoxazole is now discouraged, with amoxycillin-potassium clavulanate, cephalexin and trimethoprim becoming first-line agents for uncomplicated lower UTIs. AIM: To examine whether academic detailing, performed by a pharmacist, could modify prescribing practices for antibiotics used in the treatment of UTI in the community setting. METHODS: The intervention was conducted in Southern Tasmania, using the remainder of the State as a control area. The target group of general practitioners was sent educational material designed to assist in the appropriate prescribing of antibiotics in the treatment of UTI. A pharmacist then visited each general practitioner and discussed the rational use of antibiotics for UTIs directly with him/her. Outcomes were measured using evaluation feedback from the general practitioners and pharmacoepidemiological data, which were not linked to diagnosis. The key variable examined was the total defined daily doses (DDDs) dispensed for the recommended first-line agents (amoxycillin-potassium clavulanate, cephalexin and trimethoprim) compared with amoxycillin (3 g single-dose form) and co-trimoxazole. RESULTS: The educational programme was very well received by the general practitioners. Changes in the prescribing of antibiotics commonly used for UTIs were evident in both study regions over the course of the study, but the improvements were significantly greater in the intervention area. CONCLUSION: Educational programmes utilizing academic detailing by pharmacists can modify prescribing practices within the community setting.

Anti-Infective Agents, Urinary↗
PubMedDate not supplied

Cephalosporin resistant urinary tract infections in young children.

OBJECTIVE: To describe the antibiotic resistance pattern of bacteria causing urinary tract infection (UTI) in a cohort of Australian children under 6 years of age. METHODS: Data were collected over a 12-month period from children under 6 years of age with a provisional diagnosis of UTI made in the Emergency Department of Sunshine Hospital, Victoria. RESULTS: During the study period 100 culture-proven UTI were identified in 97 children. Three children had two episodes. Out of the 100 episodes, 39% were male, 56% were under 12 months of age at presentation and 61% were managed as outpatients. Clinical features were non-specific in the majority of cases. Hydronephrosis and vesicoureteric reflux was detected in 5.5% and 28.6%, respectively, of children with their first investigated UTI. A single bacterial isolate was cultured from 97 urines and two from three samples. Escherichia coli (n = 90) and Proteus mirabilis (n = 5) were the most common isolates. In vitro resistance to ampicillin/amoxycillin was found in 52% of isolates, to trimethoprim in 14% and to cephalothin/cephalexin in 24%. This resistance rate to first generation cephalosporins is the highest reported to date in adult or paediatric UTI in Australia. CONCLUSIONS: Ampicillin/amoxycillin or cephalothin/cephalexin may not be the optimal choice of antibiotic for the empiric treatment of UTI in this and possibly other paediatric populations.

Cephalosporin Resistance↗
PubMed2004

Neonatal urinary tract infections: analysis of the patients and recurrences.

BACKGROUND: Early diagnosis and proper treatment, including long-term follow up, are very important for neonatal urinary tract infections (UTI). METHODS: The present study reports the analysis and long-term follow-up results of 71 newborns treated for UTI. RESULTS: Forty-one per cent of patients were preterm babies. Suspected sepsis and hyperbilirubinemia were the main presenting features. Community-acquired and nasocomial UTI accounted for 63% and 37% of cases, respectively. The leading causative agents were Escherichia coli for community-acquired UTI and Klebsiella pneumoniae for nasocomial UTI. The urosepsis rate was 5%. Abnormal ultrasonography findings were present in 23% and vesicoureteral reflux was present in 15% of babies. A total of 23% of patients showed renal photopenic areas on dimercaptosuccinic acid scan. The recurrence rate was 28% occurring between 1.5 and 12 months, in particular in the first 6 months. Most of the recurrences developed in patients with no predisposing abnormalities. CONCLUSION: Pediatric nephrologic follow-up of babies experiencing UTI in the neonatal period is very important to identify the predisposing congenital abnormalities and scarred kidneys, to diagnose and to treat the recurrences earlier.

Causality↗
PubMed2004

Risk factors for febrile urinary tract infection in children with myelodysplasia treated by clean intermittent catheterization.

OBJECTIVE: To identify the factors involved in the incidence of febrile urinary tract infection (UTI) in a retrospective study of children with myelodysplasia who were treated by clean intermittent catheterization. METHODS: A total of 76 myelodysplastic children were included in the present study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both a univariate analysis and a multiple logistic regression analysis. RESULTS: Of the 76 patients, 19 (25%) had one or more episodes of febrile UTI. A univariate analysis showed low bladder compliance (<10 mL/cmH2O), detrusor overactivity, bladder trabeculation and the presence of vesico-ureteral reflux (VUR) to be significant factors in the incidence of febrile UTI. The presence of detrusor overactivity and a low bladder compliance, in addition to the presence of VUR, were found to be significant factors for the incidence of febrile UTI using a multivariate analysis. CONCLUSION: These results demonstrate that, in addition to VUR, urodynamics linked to bladder storage function disorder appear to be directly correlated with the cause of febrile UTI in children with myelodysplasia.

Age Factors↗
PubMed2004

Effect of ureteral reimplantation on prevention of urinary tract infection and renal growth in infants with primary vesicoureteral reflux.

AIM: We retrospectively reviewed the results of ureteral reimplantation in infants with primary vesicoureteral reflux (VUR) to evaluate the effect on prevention of urinary tract infection (UTI) and renal growth. MATERIALS AND METHODS: From July 1991 to December 2001, a total of 205 infants (180 boys and 25 girls) with primary VUR underwent ureteral reimplantation at the Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. Indications for surgery were high-grade reflux (grade IV-V), breakthrough UTI and non-compliance of medical treatment. Age at surgery raged from 1 to 11 months (mean, 6.4 months). Ureteral reimplantation was performed according to Cohen's method. Only two of 336 refluxing ureters required ureteral tailoring. Follow-up ranged from 12 to 110 months (mean, 64 months). Surgical outcome, frequency of UTI and individual renal growth measured by (99m)Tc-dimercaptosuccinic acid (DMSA) scintigraphy was evaluated. RESULTS: Postoperative ultrasound and voiding cystourethrography showed neither residual reflux nor ureterovesical obstruction. Contralateral low grade reflux occurred in six of 74 patients (8.1%) who had unilateral reflux preoperatively. After reimplantation, 10 patients documented 13 febrile UTI. Eleven of the 13 episodes occurred early in the postoperative period (<6 months). Frequency of febrile UTI reduced from 0.23538 before surgery to 0.00894 and 0.00081 per patient per month at 6 and 12 months after surgery, respectively. No development of renal scarring was seen in postoperative DMSA scan. Changes of differential renal function was <0.05 in all patients. CONCLUSION: The present results show ureteral reimplantation in infants is safe and very effective for the prevention of UTI. After surgical treatment in infancy, individual renal growth of children with primary VUR is stable.

Female↗