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Comparative Analysis between Top-Down and Down-Top Approach in Children with Febrile Urinary Tract Infection
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Jae Hyun Ahn, Seung Chan Jeong, Sang Don Le
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Korean J Urogenit Tract Infect Inflamm 2013;8(1):38-42. Published online April 30, 2013
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 Abstract
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- Purpose: We performed a comparative analysis of the usefulness of top-down and down-top approach in children with febrile urinary tract infection (UTI).
Materials and Methods: Among 79 children, 42 children had undergone voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scintigraphy. High grade vesicoureteral reflux (VUR) was defined as grade VI and V. We analyzed the detection rate of VUR between down-top (group I) and top-down approach (group II).
Results: The mean age of 42 children (Boys 25, girls 17) was 30.3±33.2 years. Among 42 children, 22 (52.4%) were diagnosed as VUR. Detection rate of VUR in groups I and II was 52.4% and 33.3%, respectively (p=0.078). Detection rate of VUR according to sex and age was 56.0% and 36.0% in boys (p=0.156), 47.1% and 29.4% in girls (p=0.290), and 38.9% and 16.7% in children younger than one year of age (p=0.041), and 62.5% and 45.8% in children older than one year of age (p=0.247), respectively. In high grade VUR, there was a similar detection rate of VUR, regardless of sex or age. Sensitivity, specificity, and positive prediction rate of DMSA scintigraphy in all patients and children with high grade VUR were 63.6%, 80.0%, 77.8%, and 84.6%, 80.0%, 73.3%, respectively.
Conclusions: In children with febrile UTI who were younger one year of age, down-top approach was more useful for diagnosis of VUR. Therefore, VCUG may initially be needed for diagnosis of VUR in children with febrile UTI who were younger than one year of age.
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Clinical Characteristics of Children with Febrile Urinary Tract Infection
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Chang Soo Park, Seok Gun Jung, Jae Hyun Ahn, Sang Don Lee
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Korean J Urogenit Tract Infect Inflamm 2010;5(1):57-62. Published online April 30, 2010
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Abstract
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- "Purpose: Knowledge of baseline risk of urinary tract infection (UTI) can help clinicians make informed diagnostic and therapeutic decisions. We evaluated the clinical features of children with febrile UTI. Materials and Methods: We identified 141 patients with febrile UTI, who visited for treatment. We retrospectively reviewed the sex, age, hydronephrosis, vesicoureteral reflux (VUR), concomitant disease, previous urologic surgical history, prophylactic antibiotics, voiding symptom, pathogen, used antibiotics and antibiotics resistance. Results: In 105 infants with febrile UTI who were 12 months or less, the male to female ratio was 3:1 (79 boys, 26 girls), which showed a definite male predominance. But, female children had a relatively high prevalence rate of febrile UTI, especially after the first year of life. Comorbidity of hydronephrosis was 38.1%. The most prenatal hydronephrosis persisted until presenting febrile UTI. Comorbidity of VUR was 26.1%. There was no significant difference between the prevalence of febrile UTI and the use of prophylactic antibiotics according to the VUR grade (p>0.05). The most common pathogen was E. coli (70.2%), the most commonly used antibiotics was cefotaxime (79.4%) and the most commonly resistant antibiotics was ampicillin (77.9%). Conclusions: Our results of male to female ratio according to the age are consistent with the data from large epidemiologic UTI studies. Febrile UTI of infant significantly correlated with hydronephrosis and VUR. Understanding pathogen and resistance is mandatory."
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