AUTHOR=Harper Luke , Botto Nathalie , Peycelon Matthieu , Michel Jean-Luc , Leclair Marc-David , Garnier Sarah , Clermidi Pauline , Arnaud Alexis P. , Dariel Anne-Laure , Dobremez Eric , Faure Alice , Fourcade Laurent , Boudaoud Nadia , Chaussy Yann , Collin Fideline , Huiart Laetitia , Ferdynus Cyril , Bocquet Valery , Sauvat Frederique 

TITLE=Risk factors for febrile urinary tract infection in boys with posterior urethral valves

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.971662

DOI=10.3389/fped.2022.971662

ISSN=2296-2360

ABSTRACT=Objective
Boys with posterior urethral valves (PUV) present an increased risk of febrile urinary tract infection (fUTI). Identifying specific risk factors could allow for tailoring UTI prevention. We performed a secondary analysis of the CIRCUP randomized controlled trial data to identify patient characteristics associated with a higher risk of fUTI. 
Patients and Methods
We performed a secondary analysis of the data from the CIRCUP randomized trial which included boys with PUV, randomized to circumcision and antibiotic prophylaxis vs antibiotic prophylaxis alone and followed for 2 years. There was only 1 episode of fUTI in the circumcision group vs 17 in the uncircumcised group. We therefore only studied the antibiotic prophylaxis alone group and compared age, size and weight at birth, presence of dilating VUR at diagnosis, presence of dysplasia on DMSA scan at 2 months, and nadir creatinine between children who presented a fUTI and those who did not, as well as age at first episode of fUTI.
Results
The study group consisted of 42 patients of which 17 presented at least on fUTI. Presence of dilating VUR was significantly associated with risk of fUTI (p=0.03), OR: 5.57 (CI95% = [1.13-27.52]). None of the other parameters were associated with increased risk of fUTI. We observed three distinct time periods for presenting a fUTI with a decrease in infection rate after the first 40 days of life, then at 240 days of life.
Conclusion
Febrile UTI prevention in boys with PUV could be tailored to circumcision status and presence of high-grade VUR. The rate of febrile UTIs seems to decrease after 9 months.