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PubMed2005

Recurrent urinary tract infection in the post-transplant reflux nephropathy patient: is reflux in the native ureter the culprit?

We assessed the prevalence of symptomatic, refluxing systems as a cause of recurrent urinary tract infection (UTI) in patients who underwent renal transplantation as result of renal failure from reflux nephropathy. Eleven patients from the age of 8 to 19 yr underwent renal transplantation for renal failure because of reflux nephropathy, between 1992 and 2003. Culture documented UTI were investigated and correlated with pre- and postoperative infection rates, voiding dysfunction (VD), concomitant nephrectomy, or nephroureterectomy with refluxing native remnants, and pretransplant ureteral reimplantation. Four patients with nephroureterectomies and no VD were infection free post-transplant. Two of three patients reimplanted pretransplant with a history of VD had one or more UTI per month. Patients with nephrectomies without partial ureterectomies with or without VD also had one or more UTI per month. Refluxing systems in the immunosuppressed transplant patient may play a role in UTI especially when associated with VD. Surgical intervention of native refluxing systems may be warranted.

Adolescent↗
PubMed2006

Cystoscopy in women with recurrent urinary tract infection.

OBJECTIVE: To investigate if women with recurrent urinary tract infection (UTI) warrant cystoscopy to exclude an abnormality of the lower urinary tract. This is particularly relevant given that non-invasive imaging has often been performed to exclude abnormality. Our further aims were to correlate imaging and risk factors with cystoscopic findings to determine their predictive value in finding pathology. PATIENTS AND METHODS: A database of women undergoing cystoscopy with recurrent UTI has been maintained at our institution for 10 years. We retrospectively examined this and patient records for patient demographics, and investigative and operative data. RESULTS: A total of 118 patients (mean 55 years) having recurrent UTI (mean 4.7 infections/year) were available. There were nine patients (8%) with significant abnormalities at cystoscopy: urethral stricture (six), bladder calculus (one), bladder diverticulum (one) and colovesical fistula (one). The negative predictive value (NPV) of imaging was 99% and significant (P < 0.01). Women with no risk factors for UTI had a NPV of 93% for normal cystoscopy (P > 0.05). The positive predictive value was low for imaging and risk factors in predicting cystoscopy findings. CONCLUSIONS: In our study, 8% of women had significant abnormalities detected during cystoscopy with most over 50 years. Women without risk factors for recurrent UTI and with normal imaging could have a cystoscopy omitted. Younger women are less likely to have pathology and this must be factored into decisions to perform cystoscopy.

Adult↗
PubMed2005

Is it necessary to catheterise the bladder routinely before gynaecological laparoscopic surgery?

BACKGROUND: Catheterisation of the bladder was routinely performed before gynaecological laparoscopy, but such an established practice is not evidence based and may lead to an increase in postoperative urinary symptoms and urinary tract infection. AIMS: To compare routine urethral catheterisation and non-catheterisation before laparoscopic surgery with respect to bladder injury, postoperative urinary symptoms and urinary tract infection (UTI). METHODS: This was a prospective, double blind randomised study. All women undergoing gynaecological laparoscopy, both elective and emergency, were invited to participate in the study. Cases involving bladder dissection, second trimester pregnancy and those who could not void preoperatively were excluded. Patients were randomly allocated to catheterise group and non-catheterise group. Requirement of catheterisation in the non-catheterise group, bladder injury, postoperative catheterisation, urinary symptoms and UTI were studied. RESULTS: Two hundred and seventy-nine women were recruited of whom 262 were suitable for final analysis. Each group contained 131 cases. Patient characteristics and operative parameters were comparable in both groups. There was no bladder injury. Four percent of the women in the non-catheterise group needed catheterisation and catheterisation was significantly associated with surgery longer than 90 min (P < 0.001). Postoperative UTI was insignificantly reduced in the non-catheterised group. When postoperative urinary symptoms and urinary tract infections were studied as a composite outcome, they were statistically significantly reduced in the non-catheterise group (P = 0.017). CONCLUSIONS: The policy of non-catheterisation before gynaecological laparoscopic surgery is safe and feasible. Although the reduction in UTI is insignificant, the overall postoperative urinary problems (urinary symptoms or UTI) are reduced significantly.

Adult↗
PubMed1992

Urinary tract infections and estrogen use in older women.

OBJECTIVE: To examine the relationship between exogenous estrogen use and risk of clinically diagnosed urinary tract infection (UTI) in older women. DESIGN: A case-control study. SETTING: Two hundred seventy-six general practices. PATIENTS: Cases (n = 3,616) were women, age 50-69 years, with a first recorded UTI in the calendar years 1989 or 1990. Controls (n = 19,162) were matched for age and practice. MAIN OUTCOME MEASURE: Clinical diagnosis of UTI. RESULTS: Women using estrogens for greater than or equal to 1 year had an increased risk of being diagnosed with a UTI compared to non-users, crude odds ratio (OR) 1.9 (95% CI 1.5-2.2). All of this excess risk was observed in women with intact uteri, OR 2.1 (CI 1.7-2.7). Hysterectomized women had no increased risk, OR 1.1 (CI 0.8-1.5). Controlling for diabetes, neurologic deficit, atrophic vaginitis, incontinence, and age did not affect the observed associations. CONCLUSION: Estrogen use is associated with an increased risk of UTI in older women with intact uteri but not in hysterectomized women. This observed differential effect on women with or without uteri may be explained by prescribing biases between these two groups of women, but we lack any evidence to support this conclusion over several alternative possibilities.

Age Factors↗
PubMed2005

Nursing home practitioner survey of diagnostic criteria for urinary tract infections.

OBJECTIVES: To identify clinical and laboratory criteria used by nursing home practitioners for diagnosis and treatment of urinary tract infections (UTIs) in nursing home residents. To determine practitioner knowledge of the most commonly used consensus criteria (i.e., McGeer criteria) for UTIs. DESIGN: Self-administered survey. SETTING: Three New Haven-area nursing homes. PARTICIPANTS: Physicians (n=25), physician assistants (PAs, n=3), directors/assistant directors of nursing (n=8), charge nurses (n=37), and infection control practitioners (n=3). MEASUREMENTS: Open- and closed-ended questions. RESULTS: Nineteen physicians, three PAs, and 41 nurses completed 63 of 76 (83%) surveys. The five most commonly reported triggers for suspecting UTI in noncatheterized residents were change in mental status (57/63, 90%), fever (48/63, 76%), change in voiding pattern (44/63, 70%), dysuria (41/63, 65%), and change in character of urine (37/63, 59%). Asked to identify their first diagnostic step in the evaluation of UTIs, 48% (30/63) said urinary dipstick analysis, and 40% (25/63) said urinalysis and urine culture. Fourteen of 22 (64%) physicians and PAs versus 40 of 40 (100%) nurses were aware of the McGeer criteria for noncatheterized patients (P<.001); 12 of 22 (55%) physicians and PAs versus 38 of 39 (97%) nurses used them in clinical practice (P<.001). CONCLUSION: Although surveillance and treatment consensus criteria have been developed, there are no universally accepted diagnostic criteria. This survey demonstrated a distinction between surveillance criteria and criteria practitioners used in clinical practice. Prospective data are needed to develop evidence-based clinical and laboratory criteria of UTIs in nursing home residents that can be used to identify prospectively tested treatment and prevention strategies.

Aged↗
PubMed1997

Transient pyelonephritic changes on 99mTechnetium-dimercaptosuccinic acid scan for at least five months after infection.

A prospective study was performed on 185 children with symptomatic urinary tract infection (UTI), 130F and 55M, having a median age of 0.9 y (range 0.1-9.8) at the time of UTI. The aim of the study was to find out how the 99mTechnetium-dimercaptosuccinic acid (DMSA) scan should be used to investigate UTI, and to follow the development of renal changes during pyelonephritis into subsequent permanent renal damage. All children were investigated with a DMSA scan within 5 days after admission and after 3.9-53.3 (median 9.2) weeks, and 159 were studied again after approximately 2 y (range 1.5-3.9 y). They all underwent micturition cystourethrography at the time of the second study. At the time of infection, the DMSA scan was abnormal in 85% of the children, in 58% at the first follow-up and in 36% at the second follow-up. An abnormal DMSA scan performed within 20 weeks from infection became normal in 38% of cases on the third study, while only 1/10 abnormal DMSA scans performed more than 20 weeks after infection became normal after 1.5-3.9 y. Persistent renal changes were more common in children > 4 y of age than in children < or = 1 y of age. Two months after the presenting infection, it was unusual to see a normal DMSA scan in a child with a VUR gr. > or = 3. The study suggests that DMSA changes after an index UTI may be transient for a longer period of time than has been previously considered. Therefore, in order to detect persistent changes, a DMSA scan should be performed more than 5 months after UTI.

Child↗
PubMed1992

[Analysis of urinary tract infections in hospitalized elderly patients, with particular reference to the use of diapers].

We investigated the clinical and laboratory data of 215 hospitalized patients (mean age were 76.9 +/- 12.1) to analyze both the characteristics of senile UTI and the influence of the way of urination. UTI was present in 121 of 1897 patients (6.4%), 95 of whom (78.5%) were female. Comparison of the parameters between non-infected and infected patients were as follows: body temperature was 36.57 +/- 0.64 degrees C vs. 37.49 +/- 0.77 degree C; WBC, 5410 +/- 2040/microliters vs. 7260 +/- 3230/microliters; CRP, 1.2 +/- 2.4 mg/dl vs. 3.5 +/- 3.4 mg/dl; mean class of urinary RBC, 0-1/hpf vs. 3-5/hpf; and mean class of urinary WBC, 5-10/hpf vs. 30-50/hpf. All parameters were significantly elevated (p < 0.001) in the patients with UTI. The rate of detection of causative bacteria was 88.7%; with 14.8% Escherichia coli, 12.8% Providencia species, 9.6% Enterococci, and 8.7% Pseudomonas aeruginosa. Patients with UTI were divided into three groups according to their method of urination: normal urination, use of diapers and catheterization. Body temperature (> or = 37.5 degrees C) was 2.8%, 10.1% and 34.9%; WBC (> or = 9.000), 2.7%, 6.1%, and 14.3%; CRP, 16.9%, 36.1% and 51.1%; urine RBC (> or = 6-10/hpf), 8.4%, 7.1% and 36.1%; urine WBC (> or = 15-30/hpf), 20.4%, 44.4% and 76.9%, respectively. There was a significant difference (p < 0.05-0.001) between all parameters except for urine RBC between the normal-urination patients and diaper using patients. This investigation suggested that the use of diapers was a risk factor for UTI in elderly patients.

Adult↗
PubMed1995

[A nation-wide surveillance of pathogen in elderly patients with urinary tract infections. 1st Report: Distribution of pathogen].

A nation-wide surveillance of causative organisms was conducted on 1,699 elderly patients with UTIs aged more than 65 in 190 private clinics and 73 hospitals in August and September, 1993, in order to investigate the distribution of causative bacteria and the relationship between isolates and the background of those patients. From 1,233 of the 1699 patients, 1,636 strains were isolated. E. coli was isolated most frequently (30%). in male and older patients, less E. coli were isolated, while more attenuated Gram negative rods such as NFGNR including P. aeruginosa were found. A similar trend was observed in uncomplicated UTIs isolates in this study. More E. coli were isolated from patients with stronger subjective symptoms while more bacteria other than E. coli were isolated in those with weaker subjective symptoms. From the above findings, it was confirmed that a high recovery rate of opportunistic pathogen which is less susceptible to various antibacterials is one the refractory factors in elderly patients with UTIs. Therefore, it is necessary to select a suitable antibacterial that can be used for complicated UTIs in elderly patients even when diagnosed as uncomplicated UTIs. Regardless of the size of the clinic or hospital, when treating elderly patients, with unsatisfactory results in initial treatment and with less subjective symptoms the physician must bear this in mind.

Aged↗
PubMed1995

[A nation-wide surveillance of pathogen in elderly patients with urinary tract infections. 2nd Report: Sensitivities of pathogen for oral antibacterial agents].

A nation-wide surveillance of sensitivities of bacteria, which were isolated from elderly patients with UTIs aged more than 65 in 190 private clinics and 73 hospitals, for oral antibacterials, CPFX, OFLX, NFLX, CPDX and CCL, was conducted in August and September in 1993. Antibacterial activities of 5 agents against all 1,511 strains were intensified in CPFX, OFLX, NFLX, CPDX and CCL in that order. Major pathogens such as Enterobacteriaceae, E. faecalis, Staphylococcus spp. and P. aeruginosa were more susceptible to fluoroquinolones than cephems. The rate of resistant strains to antibacterials was higher in isolates from older patients, patients with complicated UTIs and with indwelling catheter. The representative of resistant strains was P. aeruginosa, and about 50% of the strains of P. aeruginosa were resistant to even CPFX which had the most superior antibacterial activity among the 5 agents. About 40% of the S. aureus were MRSA, which were almost resistant to the 5 agents. From the above findings, it was confirmed that a high recovery rate of strains which is less susceptible to various antibacterials is one of the refractory factors in elderly patients with UTIs, particularly in complicated UTIs and with indwelling catheter. Regardless of the size of the clinic or hospital, Fluoroquinolones are more suitable for the treatment of elderly patients with UTIs than cephems.

Aged↗
PubMed2001

Antimicrobial activity of intraurethrally administered probiotic Lactobacillus casei in a murine model of Escherichia coli urinary tract infection.

The antimicrobial activity of the intraurethrally administered probiotic Lactobacillus casei strain Shirota against Escherichia coli in a murine urinary tract infection (UTI) model was examined. UTI was induced by intraurethral administration of Escherichia coli strain HU-1 (a clinical isolate from a UTI patient, positive for type 1 and P fimbriae), at a dose of 1 x 10(6) to 2 x 10(6) CFU in 20 microl of saline, into a C3H/HeN mouse bladder which had been traumatized with 0.1 N HCl followed immediately by neutralization with 0.1 N NaOH 24 h before the challenge infection. Chronic infection with the pathogen at 10(6) CFU in the urinary tract (bladder and kidneys) was maintained for more than 3 weeks after the challenge, and the number of polymorphonuclear leukocytes and myeloperoxidase activity in the urine were markedly elevated during the infection period. A single administration of L. casei Shirota at a dose of 10(8) CFU 24 h before the challenge infection dramatically inhibited E. coli growth and inflammatory responses in the urinary tract. Multiple daily treatments with L. casei Shirota during the postinfection period also showed antimicrobial activity in this UTI model. A heat-killed preparation of L. casei Shirota exerted significant antimicrobial effects not only with a single pretreatment (100 microg/mouse) but also with multiple daily treatments during the postinfection period. The other Lactobacillus strains tested, i.e., L. fermentum ATCC 14931(T), L. jensenii ATCC 25258(T), L. plantarum ATCC 14917(T), and L. reuteri JCM 1112(T), had no significant antimicrobial activity. Taken together, these results suggest that the probiotic L. casei strain Shirota is a potent therapeutic agent for UTI.

Administration, Intravesical↗
PubMed1996

Lipopolysaccharide-responder and nonresponder C3H mouse strains are equally susceptible to an induced Escherichia coli urinary tract infection.

Host defense against bacterial urinary tract infections (UTI) includes both inflammatory and immune responses to infecting bacteria. The cellular events leading up to local inflammation are thought to be under genetic control and initiated by lipopolysaccharides (LPS) of gram-negative bacteria such as Escherichia coli. It has been previously reported that mice which lack functional Lps genes are more susceptible to induced E. coli UTI than mice with normal mitogenic responses to LPS. In contrast to these findings, data in this report demonstrate that LPS-responder and nonresponder C3H mouse strains are equally susceptible to E. coli UTI. When C3H/OuJ (Lps(n)/Lps(n)) and C3H/HeJ (Lps(d)/Lps(d)) were intravesically inoculated with equal numbers of uropathogenic E. coli organisms, neither strain was able to effectively resolve the induced UTI. The inability of C3H/OuJ mice to combat the infection was not due to an impaired response to LPS, nor could defect in the local inflammatory response be identified. The results indicate that factors other than LPS responsiveness are also important in determining hose resistance to UTI.

Animals↗
PubMed2006

Effect of inactivation of the global oxidative stress regulator oxyR on the colonization ability of Escherichia coli O1:K1:H7 in a mouse model of ascending urinary tract infection.

To survive within the host urinary tract, Escherichia coli strains that cause urinary tract infection (UTI) presumably must overcome powerful oxidant stresses, including the oxygen-dependent killing mechanisms of neutrophils. Accordingly, we assessed the global oxygen stress regulator OxyR of Escherichia coli as a possible virulence factor in UTI by determining the impact of oxyR inactivation on experimental urovirulence in CBA/J and C57BL (both wild-type and p47(phox-/-)) mice. The oxyR and oxyS genes of wild-type E. coli strain Ec1a (O1:K1:H7) were replaced with a kanamycin resistance cassette to produce an oxyRS mutant. During in vitro growth in broth or human urine, the oxyRS mutant exhibited the same log-phase growth rate (broth) and plateau density (broth and urine) as Ec1a, despite its prolonged lag phase (broth) or initial decrease in concentration (urine). The mutant, and oxyRS mutants of other wild-type ExPEC strains, exhibited significantly increased in vitro susceptibility to inhibition by H(2)O(2), which, like the altered growth kinetics observed with oxyRS inactivation, were reversed by restoration of oxyR on a multiple-copy-number plasmid. In CBA/J mice, Ec1a significantly outcompeted its oxyRS mutant (by >1 log(10)) in urine, bladder, and kidney cultures harvested 48 h after perurethral inoculation of mice, whereas an oxyR-complemented mutant exhibited equal or greater colonizing ability than that of the parent. Although C57BL mice were less susceptible to experimental UTI than CBA/J mice, wild-type and p47(phox-/-) C57BL mice were similarly susceptible, and the oxyR mutant of Ec1a was similarly attenuated in C57BL mice, regardless of the p47(phox) genotype, as in CBA/J mice. Within the E. coli Reference collection, 94% of strains were positive for oxyR. These findings fulfill the second and third of Koch's molecular postulates for oxyR as a candidate virulence-facilitating factor in E. coli and indicate that oxyR is a broadly prevalent potential target for future preventive interventions against UTI due to E. coli. They also suggest that neutrophil phagocyte oxidase is not critical for defense against E. coli UTI and that the major oxidative stresses against which OxyR protects E. coli within the host milieu are not phagocyte derived.

Animals↗
PubMed1991

False-positive Chlamydiazyme results during urine sediment analysis due to bacterial urinary tract infections.

Our study examined whether urinary tract infections (UTIs) would cause false-positive results when urine sediment was tested with the Chlamydiazyme (CZ) system. Thirty-six infected urine samples and fifteen controls were studied. All controls were negative. Forty-seven percent of Escherichia coli UTIs (n = 30) and 100% of Klebsiella pneumoniae UTIs (n = 4) were positive on CZ testing of urine sediment. Nine E. coli UTIs positive by CZ were negative by direct fluorescent-antibody staining. When suspensions of the pure cultures were analyzed, 47% of E. coli and 100% of K. pneumoniae samples were CZ positive. False-positive results were not related to organism biotype or urine characteristics, including pH, specific gravity, and leukocyte count. We conclude that the presence of a UTI and also bacterial contamination must be ruled out prior to urine sediment testing.

Antigens, Bacterial↗
PubMed1997

Identification of a Klebsiella pneumoniae strain associated with nosocomial urinary tract infection.

To differentiate between relapse of infection and reinfection of the urinary tract due to Klebsiella pneumoniae, 33 K. pneumoniae isolates collected from 20 patients with spinal cord injury (SCI) over 2 years were typed by genomic fingerprinting by repetitive-element PCR. Clinical isolates obtained from the same patients with recurrent episodes of urinary tract infection (UTI) revealed identical genomic fingerprints indicating relapse of UTI due to K. pneumoniae, despite appropriate antibiotic therapy. Seventeen isolates obtained from 8 of the 20 SCI patients shared a common genotype, termed RD6. Among non-SCI patients residing in other nursing units, the RD6 genotype was found in 5 of 10 patients with K. pneumoniae UTI but in only 1 of 20 patients with K. pneumoniae infection that did not involve the urinary tract, suggesting a strong association of this genotype with UTI. All RD6 isolates exhibited strong adherence (> or =50 adherent bacteria per cell) to HEp-2 cells, whereas other K. pneumoniae isolates generally did not adhere to or adhered very weakly to HEp-2 cells (< or =5 adherent bacteria per cell). Adherence was inhibited either by 4% D-mannose or by anti-type 1 fimbrial rabbit serum. These results suggest that the capacity of K. pneumoniae RD6 isolates to cause UTI may be mediated by its striking adherence to mammalian cells.

Antibodies, Blocking↗
PubMed2001

Risk factors for antibiotic-resistant Escherichia coli isolated from hospitalized patients with urinary tract infections: a prospective study.

From November 1998 to February 1999 we prospectively evaluated the prevalence of resistance to penicillins, cephalosporins, carbapenem, quinolones, aminoglycosides, and trimethoprim-sulfamethoxazole (SXT) in 320 Escherichia coli isolates isolated from hospitalized patients with acute urinary tract infections (UTIs). We also studied for these strains risk factors for resistance to amoxicillin-clavulanic acid (AMC), fluoroquinolones (FQs), and SXT. Resistance rates were consistent with those from major recent studies reported in the literature. Multivariate analyses selected the following factors as being significantly associated with E. coli resistance: (i) for resistance to AMC, prior (1 year) UTI (odds ratio [OR] = 2.71, P = 0.006), prior (1 year) urinary catheter (OR = 2.98, P = 0.0025), and prior (6 months) antibiotic exposure (OR = 2.68, P = 0.005); (ii) for resistance to FQs male sex (OR = 3.87, P = 0.03), with a trend toward significance for age >65 years (OR = 7.67, P = 0.06) and prior (1 year) UTI (OR = 2.98, P = 0.07); and (iii) for resistance to SXT, male sex (OR = 1.91, P = 0.046), hospitalization in an intermediate-term-care unit (OR = 2.18, P = 0.008), and prior (1 year) UTI (OR = 2.03, P = 0.03). Ours results suggest that prior UTI is a common risk factor for resistance to the different antibiotics tested. Although few studies on risk factors for E. coli resistance to antibiotics have been published, careful interpretation of their findings, taking into consideration the population, infection site, and period studied, should contribute to the formulation of a better strategy that can be used to overcome antibiotic resistance.

Adolescent↗
PubMed2003

Identification of a gene encoding heat-resistant agglutinin in Escherichia coli as a putative virulence factor in urinary tract infection.

Escherichia coli causes the vast majority of urinary tract infections (UTI) in both ambulatory and hospital patients. Several uropathogenic virulence factors have been identified, but half of all E. coli isolates that cause UTI have none or only one of the known virulence factors. Thus, it is reasonable to presume that other bacterial factors may be important in UTI pathogenesis. In order to find additional uropathogenic E. coli genes, we used genomic subtraction to identify DNA regions present in a uropathogenic strain of E. coli (1128-11). Genomic subtraction yielded 40 tester-specific fragments, including a novel heat-resistant agglutinin (hra) gene fragment. hra occurred in 55% of 486 UTI strains compared to 28% of 165 rectal strains (P = 0.001). The hra gene in 1128-11 was cloned, sequenced, and found to have 91% homology to the hra gene from E. coli meningitis strain RS218. The genetic organization of genes flanking hra in 1128-11 is distinct from the hra found in E. coli strains J96 and RS218. In our UTI and rectal specimen collections, hra was positively associated with a number of known virulence genes, including pathogenicity island genes hly and cnf, which are absent in 1128-11. The presence of hra in 1128-11 independent of hly/cnf suggests multiple mechanisms by which hra can be acquired by pathogenic E. coli strains. The flanking genes suggest that in 1128-11, hra may be part of a novel variant of a pathogenicity island V.

Adhesins, Bacterial↗
PubMed2005

The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection.

BACKGROUND: Childhood urinary tract infection (UTI) with or without vesicoureteric reflux (VUR) may predispose to renal scarring. There is no clear consensus in the literature regarding imaging following UTI in infancy. AIMS: To define the role of cystography following a first UTI in children aged under 1 year, when urinary tract ultrasonography (US) is normal. METHODS: Retrospective data collection of 108 children (216 renal units) aged under 1 year at the time of a bacteriologically proven UTI. All had a normal US and underwent both catheter cystogram and DMSA test. Sensitivity, specificity, likelihood ratios positive and negative, and diagnostic odds ratio were calculated for VUR on cystography versus scarring on DMSA. RESULTS: VUR was shown in 25 (11.6%) renal units. Scarring on DMSA was seen in 8 (3.7 %) kidneys. Only 16% of kidneys with VUR had associated scarring; 50% of scarred kidneys were not associated with VUR. The likelihood ratio positive was 4.95 (95% CI 2.22 to 11.05) and the likelihood ratio negative was 0.56 (95% CI 0.28 to 1.11). The diagnostic odds ratio was 8.9, suggesting that cystography provided little additional information. CONCLUSION: Since only 16% of children with VUR had an abnormal kidney, the presence of VUR does not identify a susceptible population with an abnormal kidney on DMSA. In the context of a normal ultrasound examination, cystography contributes little to the management of children under the age of 1 year with a UTI. In this context, a normal DMSA study reinforces the redundancy of cystography.

Cicatrix↗
PubMed1995

Radiological evidence of constipation in urinary tract infection.

Little objective evidence has been published to support the claim that constipation is an important contributory factor in recurrent urinary tract infection (UTI) in childhood. Using a radiological scoring system, two observers assessed faecal loading from abdominal radiographs of children with proved UTIs. There was a significant increase in the degree of faecal loading in children with UTI when compared with controls (r = 0.237). This difference was mainly accounted for by girls with recurrent (greater than five) UTIs. This study confirms an association between recurrent UTI and faecal loading. Further studies are needed to establish if there is a causal relationship and benefits from treatment.

Adolescent↗