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PubMed2000

The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection.

BACKGROUND: Catheter-associated urinary tract infection (UTI) is associated with increased morbidity, mortality, and costs. A recent meta-analysis concluded that silver alloy catheters reduce the incidence of UTI by 3-fold; however, clinicians must decide whether the efficacy of such catheters is worth the extra per unit cost of $5.30. OBJECTIVE: To assess the clinical and economic impact of using silver alloy urinary catheters in hospitalized patients. METHODS: The decision model, performed from the health care payer's perspective, evaluated a simulated cohort of 1000 hospitalized patients on general medical, surgical, urologic, and intensive care services requiring short-term urethral catheterization (2-10 days). We compared 2 catheterization strategies: silver alloy catheters and standard (noncoated) urinary catheters. Outcomes included the incidence of symptomatic UTI and bacteremia and direct medical costs. RESULTS: In the base-case analysis, use of silver-coated catheters led to a 47% relative decrease in the incidence of symptomatic UTI from 30 to 16 cases per 1000 patients (number needed to treat = 74) and a 44% relative decrease in the incidence of bacteremia from 4.5 to 2.5 cases per 1000 patients (number needed to treat = 500) compared with standard catheters. Use of silver alloy catheters resulted in estimated cost savings of $4.09 per patient compared with standard catheter use ($20.87 vs $16.78). In a multivariate sensitivity analysis using Monte Carlo simulation, silver-coated catheters provided clinical benefits over standard catheters in all cases and cost savings in 84% of cases. CONCLUSIONS: Using silver alloy catheters in hospitalized patients requiring short-term urinary catheterization reduces the incidence of symptomatic UTI and bacteremia, and is likely to produce cost savings compared with standard catheters.

Alloys↗
PubMed2000

A randomized crossover study of silver-coated urinary catheters in hospitalized patients.

BACKGROUND: Urinary tract infections (UTIs) account for 30% to 40% of nosocomial infections resulting in morbidity, mortality, and increased length of hospital stay. OBJECTIVE: To assess the efficacy of a silver-alloy, hydrogel-coated latex urinary catheter for the prevention of nosocomial catheter-associated UTIs. METHODS: A 12-month randomized crossover trial compared rates of nosocomial catheter-associated UTI in patients with silver-coated and uncoated catheters. A cost analysis was conducted. RESULTS: There were 343 infections among 27,878 patients (1.23 infections per 100 patients) during 114,368 patient-days (3.00 infections per 1000 patient-days). The relative risk of infection per 1000 patient-days was 0.79 (95% confidence interval, 0.63-0.99; P =.04) for study wards randomized to silver-coated catheters compared with those randomized to uncoated catheters. Infections occurred in 291 of 11,032 catheters used on study units (2.64 infections per 100 catheters). The relative risk of infection per 100 silver-coated catheters used on study wards compared with uncoated catheters was 0.68 (95% confidence interval, 0.54-0.86; P =.001). Fourteen catheter-associated UTIs (4.1%) were complicated by secondary bloodstream infection. One death appeared related to the secondary infection. Estimated hospital cost savings with the use of the silver-coated catheters ranged from $14,456 to $573,293. CONCLUSIONS: The risk of infection declined by 21% among study wards randomized to silver-coated catheters and by 32% among patients in whom silver-coated catheters were used on the wards. Use of the more expensive silver-coated catheter appeared to offer cost savings by preventing excess hospital costs from nosocomial UTI associated with catheter use. Arch Intern Med. 2000;160:3294-3298.

Adult↗
PubMed2000

Renal function 16 to 26 years after the first urinary tract infection in childhood.

OBJECTIVE: To evaluate renal function in a population-based cohort with urographic renal scarring after childhood urinary tract infection (UTI). DESIGN: Follow-up investigation 16 to 26 years after the first recognized UTI. SETTING: Outpatient university clinic for children with UTI serving the local area. PATIENTS: From the original cohort of 1221 consecutive children with first UTI diagnosed during 1970 to 1979, 57 (41 females and 16 males; mean age, 24.5 years) of 68 with nonobstructive renal scarring participated as well as 51 (38 females and 13 males; mean age, 24.9 years) matched subjects without scarring. MAIN OUTCOME MEASURE: Glomerular filtration rate (GFR) measured by chromium 51-EDTA clearance, expressed as milliliters per minute per 1.73 square meters. RESULTS: Median GFR was 99 in both those with and without renal scarring. In patients with unilateral scarring, the total GFR remained unchanged over the years whereas the individual GFR of the scarred kidneys declined significantly from 46 to 39. In 7 patients with bilateral scarring, the GFR declined from 94 to 84 (P = .14); compared with those with unilateral scarring, the GFR was significantly lower at follow-up (P = .007). Median urinary albumin-creatinine ratio was 1.2 and 0.6 mg/mmol in those with scarring and those without, respectively (P = .30). CONCLUSIONS: The GFR 2 decades after the first recognized UTI in childhood was well preserved. However, a significant reduction of individual renal GFR in the unilaterally scarred kidneys indicates that further follow-up is required. Although there were few patients with bilateral scarring, a more serious prognosis can be expected among them.

Adolescent↗
PubMed2000

Clinical decision rule to identify febrile young girls at risk for urinary tract infection.

OBJECTIVE: To develop a clinical prediction rule to identify febrile young girls needing urine culture for evaluation of urinary tract infection (UTI). DESIGN: Prospective cohort study. SETTING: Urban children's hospital emergency department. PATIENTS: All girls younger than 2 years (N = 1469) presenting to the emergency department with fever (temperature > or =38.3 degrees C) and without an unequivocal source of fever during a 12-month period. MAIN OUTCOME MEASURES: The outcome of interest was UTI, defined as a catheterized urine culture with pure growth of 10(4) colonies/mL or greater. Candidate predictors included demographic, historical, and physical examination variables. Clinical prediction rules were developed using multiple logistic regression after screening variables for univariate association and reliability. RESULTS: The presence of 2 or more of the following 5 variables-less than 12 months old, white race, temperature of 39.0 degrees C or higher, fever for 2 days or more, and absence of another source of fever on examination-predicted UTI with a sensitivity of 0.95 (95% confidence interval, 0.85-0.99) and a specificity of 0.31 (95% confidence interval, 0.28-0.34). In the study population, with an overall prevalence of UTI of 4.3%, the positive predictive value of a score of 2 or more was 6.4% and the negative predictive value of a score of less than 2 was 0.8%. CONCLUSION: Using this clinical decision rule, a strategy of obtaining urine cultures from girls younger than 2 years with a score of 2 or more would lead to identification of 95% of children with UTI and elimination of 30% of unnecessary urine cultures.

Decision Making↗
PubMed1979

Urinary tract infections in kidney transplant recipients.

In 65 kidney transplant recipients who were followed up for a mean period of 14.7 months, the incidence of urinary tract infection (UTI), and how the incidence was affected by length of graft survival, age, HLA-A and HLA-B matches, complications, duration of Foley catheter use, and other aspects, were examined. The total incidence of infection included an unexpectedly high rate of late infections. The incidence was found to be statistically increased with nephrectomy, splenectomy, recatheterization, and age older than 40 years. There was no correlation noted with graft source, antigen match, graft loss, or previous history of UTI. A group of patients with persistent UTI was noted and an inability to suppress UTI with long-term therapy with antibiotics was found. The asymptomatic nature of most of the UTIs confirmed the need for frequent periodic cultures of urine in the immunosuppressed patient.

Adult↗
PubMed1994

Effects of urinary trypsin inhibitor on the invasion of reconstituted basement membranes by ovarian cancer cells.

Using the human ovarian cancer cell line HOC-1, we investigated the effects of urinary trypsin inhibitor (UTI) purified from human urine and its related synthetic peptides on the invasive potential of cancer cells in an in vitro assay. Invasiveness of tumor cells was determined using a modified Boyden chamber and a reconstituted basement membrane Matrigel. Three peptides (peptide 1, peptide 2, and peptide 3), representing sequences within UTI, were synthesized. HOC-1 cells showed detectable and reproducible levels of expression of surface urokinase-type plasminogen activator (uPA) and plasminogen/plasmin by cell ELISAs and enzyme assays. UTI was found to strongly inhibit plasmin and human leukocyte elastase (HLE). Peptide 2 and peptide 3 specifically inhibit HLE and plasmin activity respectively. Peptide 1 has essentially no inhibitory activity. Treatment with UTI and peptide 3 reduces the incidence of invasion, whereas peptide 1 and peptide 2 do not affect invasion. The inhibitory effect on cell invasion is dose-dependent. The proteolytic enzyme plasmin may be involved in human ovarian cancer invasion in extracellular matrix degradation, and the use of UTI and peptide 3 that inhibits plasmin specifically reduces invasion by tumor cells.

Amino Acid Sequence↗
PubMed1998

Inhibitory effect of protease inhibitor on endothelial cell activation.

BACKGROUND: Endothelial cells (EC) are important for regulating the hemostatic balance of prothrombotic and antithrombotic activities. Proinflammatory cytokines such as tumor necrosis factor-alpha (TNFalpha) play an important role in the regulation of EC and also regulate the production of plasminogen activator inhibitor type 1 (PAI-1), which is an EC-producing factor with the inhibitory activity of fibrinolysis, and the expression of intercellular adhesion molecule-1 (ICAM-1), which is an adhesion molecule that plays an important role in inflammation. Protease inhibitors such as gabexate mesilate (GM) and ulinastatin (UTI) have been shown to improve the microcirculatory environment and reduce tissue damage, but the mechanism for this has yet to be fully elucidated. We investigated the effect of GM or UTI on EC regarding PAI-1 synthesis and ICAM-1 expression. METHODS: Human umbilical vein endothelial cells (HUVECs) were obtained and stimulated with TNFalpha. GM or UTI was added to HUVECs just before TNFalpha stimulation. The PAI-1 activity in the culture medium of HUVECs was measured by using an enzymatic assay kit. The PAI-1 mRNA expression was assayed by a semiquantitative reverse transcriptase polymerase chain reaction assay. The ICAM-1 expression on HUVECs was assayed by a flow cytometric analysis. RESULTS: GM inhibited the PAI-1 synthesis of HUVECs stimulated with TNFalpha in a dose-dependent manner as shown by the mRNA expression. However, UTI was not able to inhibit PAI-1 synthesis. In contrast, both GM and UTI significantly inhibited the ICAM-1 expression on HUVECs stimulated with TNFalpha. CONCLUSIONS: These data suggest that GM may thus provide a beneficial effect which improves the microcirculatory environment and prevents tissue damage by inhibiting the activation of the vascular EC themselves.

Base Sequence↗
PubMed1999

Protective effects of ulinastatin against ischemia-reperfusion injury.

We investigated the protective effect of urinary trypsin inhibitor (ulinastatin: UTI) in vitro, in relation to the neutrophil activity in hepatic ischemia/reperfusion (I/R) injury. The rat liver was removed and preserved in cold Ringer's lactate solution for 60 min, followed by 120 min of reperfusion with oxygenated perfusate. The rats were divided into four groups (n = 8 in each group). The livers were perfused with Krebs-Henseleit (K-H) solution containing no additives in group 1, 50,000 U/kg of UTI in group 2, 3.5 x 10(6) of neutrophils in group 3, and both neutrophils and UTI in group 4. In group 3, the AST and ALT levels were always higher than those in other three groups at any point evaluated (P < 0.01) and the LDH levels were observed to be significantly higher than those in other three groups at 0, 5, 10, 60, and 90 min after reperfusion (P < 0. 01). These increase were suppressed by additional pretreatment with UTI in group 4. The bile flow during reperfusion was significantly suppressed in group 3 compared to that of group 4, at both 30 (P < 0. 01) and 60 (P < 0.05) min after reperfusion. The MPO activity after reperfusion in group 3 also significantly increased compared to other three groups (P < 0.01). These data thus suggest that UTI ameliorated the ischemia/reperfusion injury in vitro by inhibiting of neutrophil accumulation in the postischemic liver.

Animals↗
PubMed1993

Lack of association between hemolysin production and acute inflammation in human urinary tract infection.

Hemolysins are cytolytic proteins which have been extensively characterized at the molecular level, however, their in vivo functions remain unclear. This study analyzed the association of hemolysin production with the inflammatory response in patients with urinary tract infection (UTI). Infants and children with their first episode of UTI (n = 644) were followed prospectively. The body temperature, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), urinary leucocyte count and renal concentrating capacity were used as measures of the inflammatory response. The hemolytic genotype (hly) of the Escherichia coli strain from each UTI episode was defined by DNA-DNA hybridization, and the phenotype by hemolysis in blood agar. There was no significant increase in the level of fever, CRP, ESR, or decrease in renal concentrating capacity during UTI episodes caused by hly positive compared to hly negative E. coli. Multiple regression analysis did not demonstrate significant associations of hly with elevated fever, CRP, ESR or reduced renal concentrating capacity. In contrast, patients infected with P fimbriated E. coli strains had higher fever, CRP, ESR and lower renal concentrating capacity than those infected with other strains. This association was not influenced by the hly genotype of the P fimbriated strains. The frequency of hly+ strains was not significantly higher in the subset of patients assigned a diagnosis of acute pyelonephritis compared to asymptomatic bacteriuria. This was in contrast to P fimbriae, which were accumulated in acute pyelonephritis. The results suggested that the acute inflammatory response to E. coli UTI is independent of hemolysin production. The inflammatogenic potential of uropathogenic E. coli clones was better described by the presence or absence of P-fimbriae than by hemolysin.

Child, Preschool↗
PubMed1986

Urinary tract infections and renal papillary necrosis in alcoholism.

An enhanced frequency and morbidity of urinary tract infections (UTI) have been observed in association with alcoholism and liver disease. The causes of these phenomena may relate, in part, to the defects in humoral and cellular immune mechanisms that occur in alcoholism. Urinary catheterization is the most common cause of UTI in hospitalized alcoholics. The severity of the sequelae of UTI in alcoholism is demonstrated by the unusually frequent occurrence of renal papillary necrosis (RPN) in conjunction with pyelonephritis in these patients. Indeed, in over 90% of the reported cases of RPN occurring with alcoholism or liver disease, pyelonephritis has been a contributing factor. The proclivity to medullary ischemia and RPN in this patient group may be, at least in part, a result of interstitial renal edema secondary both to infection and the effect of ethanol per se and to renal arterial vasoconstriction that occurs in cirrhosis. The frequency with which death due to sepsis or renal failure occurs in association with UTI in alcoholics obliges the physician to exercise caution in the prevention and treatment of UTI in these patients.

Alcoholism↗
PubMed1995

Update on dimercaptosuccinic acid renal scanning in children with urinary tract infection.

The dimercaptosuccinic acid (DMSA) renal scan is a method for assessing kidney function. Indications for DMSA scanning in children with urinary tract infection (UTI), as well as timing, have changed. Pitfalls in interpreting DMSA scans include: (1) acute pyelonephritis (APN), (2) tubular dysfunction, (3) hypertension, (4) use of captopril in patients with renovascular hypertension and (5) duplex kidneys. Interpretation of DMSA scans in children with UTI vary according to timing and clinical setting. During the course of a febrile UTI a DMSA scan may reveal a normal kidney, APN or a non-functioning, small and/or ectopic kidney. In the absence of UTI (up to 6 months) in children with vesicoureteric reflux a DMSA scan may indicate a normal kidney, renal scarring (reflux nephropathy), occult duplex kidney and allows the progression of scarring and hypertrophy of normal areas of the kidney to be followed anatomically. The DMSA renal scan in now the most reliable test for the diagnosis of APN. The transient abnormalities due to APN can occur in normal or scarred kidneys. Lesions due to reflux nephropathy (defined as a defect in the renal outline or contraction of the whole kidney) are permanent. Intravenous urography reveals renal abnormalities later than the DMSA scan. If abnormalities are seen on a DMSA scan performed during the course of APN it is impossible to predict the outcome: they can progress to permanent scarring or heal completely. An abnormal DMSA scan during a febrile UTI allows the identification of children at risk of developing renal scars. These children should be carefully investigated, maintained on long-term quimioprophylaxis and followed.

Acute Disease↗
PubMed1991

A practical approach to evaluating urinary tract infection in children.

After a first urinary tract infection (UTI), all children require an evaluation with imaging studies to screen the urinary tract for anatomic abnormalities and for reflux. Ultrasonography and voiding cystography readily accomplish this and are recommended, knowing that such a recommendation is controversial. While the likelihood for reflux-induced renal damage is age related, the presence of reflux in any child with infection is clinically important for management. Abnormal screening results or recurrence of infection warrant further radiographic testing. However, imaging studies are necessary but do not constitute sufficient evaluation for UTI because the etiology of infection is only rarely identified with these tests. Sorely neglected in most recommended protocols for evaluating urinary infection is an investigation for micturitional disturbances which may be responsible for the infections. Treatment of these conditions may actually prevent recurrence of infection. Controversy surrounding the proper imaging evaluation for UTI appears to be mis-directed. Instead of arguing about which imaging study should be performed or which child with a first UTI should have a cystogram, our patients might be better served if we wondered why traditional protocols for evaluating UTI deal only with imaging studies.

Child↗
PubMed1977

[Occurence, significance and clinical consequences of lipid A antibody titers in patients with urinary tract infection (author's transl)].

Lipid A antibody titers were measured by the passive hemolysis test in 349 humans. In two out of 20 healthy adults and 16 out of 18 children with recurrent urinary tract infection (UTI) in the presence of anomalies anti-lipid A antibodies were present. In contrast, no titers were found in 23 newborn babies. In a group of 156 patients with acute UTI, 28% revealed positive titers, whereas in a group of 132 patients with recurrent UTI titers occurred in 81%. In a selected group of 132 patients with recurrent infections of the upper tract 59 (=96%) showed definite titers. There was no difference in the development of anti-lipid A antibodies between men and women and the height of the titers did not correlate with the clinical picture of the disease (acute or chronic). The combination of proteinuria and anti-lipid A antibodies indicates the presence of recurrent UTI or chronic pyelonephritis with about 90% accuracy. The titers are caused by immunogenically active lipid A in the body. Since lipid A has the ability to remain in the renal tissue for a long period of time and thereby to maintain the inflamatory response, long-term antimicrobial prophylaxis (six months) should be given to patients with a high risk of recurrent UTI.

Adolescent↗
PubMed1985

Cefotaxime for the treatment of gram-positive urinary tract infection.

Urinary tract infections (UTI) due to gram-positive bacteria are fairly uncommon. In order to investigate the efficacy of treatment for UTI secondary to gram-positive rods, we performed a non-comparative study on the effect of cefotaxime in 64 patients with gram-positive UTI. Patients with a history of hypersensitivity to cephalosporins and penicillin as well as patients who had received antibiotic treatment within 48 hours after the administration of cefotaxime, patients with hepatic disease and patients with fatal progressive disease were excluded from the study. UTI was confirmed by positive cultures with a colony count of greater than or equal to 100,000 cfu/ml of gram-positive organisms before treatment with cefotaxime. When sepsis or bacteriuria occurred after two days of hospitalization, the UTI was considered nosocomial. The most common microorganism isolated was Staphylococcus aureus, followed by Streptococcus faecalis. 30% of the patients showed polymicrobic bacteriuria, especially in association with gram-negative bacteria (70%). A high frequency of predisposing factors was present in the urinary tract, mainly obstruction, indwelling catheters, surgery and chronic debilitating diseases. Seven patients developed bacteremia. All patients were treated with cefotaxime i.m. or i.v. at a daily dosage ranging between 4 and 12 g. Urine cultures were repeated five days after the beginning of treatment and again two to three weeks after the end.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Urinary tract infection in renal transplant patients.

The incidence of urinary tract infections (UTI) in 299 renal graft transplantations (281 patients) was analyzed. UTI episodes were demonstrated in 185 grafts (62%), most frequently in the first month after transplantation. The infectious episodes were mostly recurrent. Persistent infection, detected in 11% of grafts, was associated with urologic complications in almost all cases. No significant correlation between the primary renal disease and the UTI rate was found, and there was no significant correlation between UTI and sex. In grafts with recurrent infectious episodes, vesicoureteral reflux was more common. No significant difference was observed in the residual bladder volume, irrespective of whether infection was present or not. The urine was infected by a number of hospital strains, particularly Klebsiella, Enterobacter and indole-positive Proteus strains. An overwhelming majority of UTI episodes (96%) were asymptomatic. Antibody-coated bacteria in urinary sediment were present in only 19% of infectious episodes. Clinically severe courses were observed in infections associated with urologic complications (especially urinary fistulae); these were difficult to treat and were often a source of sepsis and a risk factor in graft loss.

Adolescent↗
PubMed2004

Elevated levels of secretory immunoglobulin A (sIgA) in urinary tract infections.

OBJECTIVE: Urinary secretory IgA (sIgA), an immunoglobulin synthesized locally in mucosal surface is an important immunological defense in preventing bacterial adherence to periurethral epithelia and uroepithelia. Therefore attempts were made to measure secretory IgA in the urine of children with urinary tract infections (UTI), by using sIgA specific ELISA. METHODS: Fresh or unprocessed urine samples from healthy donors (children and adults N=10 each), 68 children and 17 Adults with UTI were tested for the presence of sIgA. RESULTS: The level of sIgA in 10 healthy normal children was 2.7 +/- 0.94 ug/ml and that in 10 healthy adults was 5.2 +/- 0.73 ug/ml. Children with UTI showed highly elevated levels of sIgA amounting to 279 +/- 80 ug/ml (p<0.001). It was interesting to note that 96% of children and 76% of adults with UTI had sIgA level significantly above that of +/- 2SD of respective controls (287 +/- 99 and 80 +/- 48 ug/ml respectively). On culturing the urine obtained from these children the colonies identified were E. coil about 46%, Klebsiella about 24% and Pseudomonas about 24%. The sIgA antibody from urine samples assessed by indirect immunoflourescense. specifically reacted with the respective organism. CONCLUSION: Taken together the results show that the presence of sIgA not only correlated with the UTI in children as well in adults but sIgA seems to be directed to the infective agent and can also be used to identify the type of infection. Thus measurement of urine antibody levels may provide an alternative marker of host responses to infection, which can be used either as a simple screening test or could be useful to assist alongwith other tests in establishing a diagnosis.

Adolescent↗
PubMed2000

[Significance of bacterial prostatic colonization for nosocomial urinary tract infections after transurethral prostate resection].

Nosocomial urinary tract infections (UTI) are frequent complications after transurethral prostatectomy. The resection itself, postoperative catheterization and the prostate are possible causes of these infections. In this prospective study we investigated the influence of bacterial prostatic colonization on the incidence of postoperative urinary tract infections and inflammatory complications. In 78 patients we observed in 42 cases (53.8%) a bacterial prostatitis. In 14 patients (17.9%) we found nosocomial UTI's and in 12 patients (15.4%) inflammatory complications. The incidence of postoperative UTI's increase significantly in patients with positive prostate-cultures. On the other hand we only found corresponding prostate- and postoperative urine-cultures in less than 50%. The presented data are not sufficient to conclude the kind of relevance of bacterial prostatic colonization for postoperative UTI's in transurethral prostatectomy. Under consideration of the significant increase of nosocomial UTI's in patients with positive prostate cultures a perioperative antibiotic prophylaxis seems to be required in general.

Aged↗
PubMed2000

The initial renal ultrasound examination in children with urinary tract infection: the prevalence of dilated uropathy has decreased.

BACKGROUND: Pelvocalyceal dilatation (PCD) is often detected by sonography during the prenatal period. Prenatal detection of PCD should affect the prevalence of PCD in children with urinary tract infection (UTI). PURPOSE: To determine the prevalence of abnormal sonographic findings in a population of children undergoing first imaging evaluations after UTI and to determine if the prevalence has changed from an earlier study at the same institution. MATERIALS AND METHODS: The findings on consecutive first renal and bladder sonographic examinations in 844 children (745 girls, 99 boys) with UTI were retrospectively reviewed. Cystograms were performed in 743/844 (494 nuclear, 249 fluoroscopic). Only children with known congenital malformations or other significant disease were excluded. RESULTS: Sonography was abnormal in 141/844 (16.7%). PCD was noted in 27/844 (3.2%), with mild PCD in 18/844 (2.1%) and moderate or severe PCD in 9/844 (1.1%). Hydroureter without PCD was noted in 6/844 (0.7%). Parenchymal abnormalities were present in 42/844 (5.0%) and bladder wall thickening in 43/844 (5.1%). Vesicoureteral reflux was present in 186/743 (25.0%). When compared to historical controls, PCD and hydroureter were significantly less prevalent than 1 decade earlier (P < 0.0001). CONCLUSION: The prevalence of PCD in children under first imaging evaluation for UTI declined significantly during the last decade. These data may be useful in the design of imaging strategies for children with UTI.

Age Factors↗