SavedAdd your journal

Journals / Çukurova Anestezi ve Cerrahi Bilimler Dergisi / 2026 / Cilt: 9 Sayı: 3

Risk Factors for Recurrent Urinary Tract Infection in Children with Vesicoureteral Reflux

VUR Tanılı Hastalarda Tekrarlayan İYE için Risk Faktörleri

Bahriye Uzun Kenan(Ankara Etlik City Hospital)0000-0002-8248-0436
Asiye Gültekin Soylu(Ankara Etlik Şehir Hastanesi)0009-0000-6229-1331
Tülin Güngör(Ankara Etlik Şehir Hastanesi)0000-0002-5881-1565
Evrim Kargın Çakıcı(Ankara Etlik Şehir Hastanesi)0000-0002-1697-6206
Aysun Çaltık Yılmaz(Ankara Etlik Şehir Hastanesi)0000-0003-0774-4419
Pages
1109–1116
Publication Date
2026-09-30
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Patients with high-grade and bilateral VUR may benefit from closer follow-up and individualized management.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Aim: Recurrent febrile urinary tract infection (UTI) in children with vesicoureteral reflux (VUR) is associated with renal scarring and long-term morbidity.
📊
Key Findings & Data:Materials and Methods: We retrospectively reviewed 100 children diagnosed with VUR at the Pediatric Nephrology Clinic of Ankara Etlik City Hospital be-tween January 2023 and May 2026.
💡
Conclusion & Impact:Patients with high-grade and bilateral VUR may benefit from closer follow-up and individualized management.
🔬Design:Review & Systematic Survey
📍Scope:2023 Verileri
⚙️Variables:çocuk · idrar yolu enfeksiyonu · vezikoüreteral reflü

Abstract

Aim: Recurrent febrile urinary tract infection (UTI) in children with vesicoureteral reflux (VUR) is associated with renal scarring and long-term morbidity. This retrospective cohort study aimed to identify clinical and imaging factors associated with recurrent febrile UTI in children with VUR. Materials and Methods: We retrospectively reviewed 100 children diagnosed with VUR at the Pediatric Nephrology Clinic of Ankara Etlik City Hospital be-tween January 2023 and May 2026. Recurrent febrile UTI was defined as two or more fe-brile UTI episodes during follow-up. Patients were divided into two groups based on re-current febrile UTI status, and demographic characteristics, VUR grade, febrile UTI history, DMSA scintigraphy findings, laboratory results, and treatment data were compared. Fac-tors associated with recurrent febrile UTI were evaluated by logistic regression analysis. Results: The median age at diagnosis was 36.5 months (3.25–81.0), and 35 patients (35%) experienced recurrent febrile UTI. High-grade VUR (p=0.038), bilateral involvement (p=0.045), and DMSA scarring (p=0.012) were significantly associated with recurrence; age, age at diagnosis, age at first UTI, and prophylaxis duration were also significantly higher in the recurrent-febrile-UTI group (all p<0.05). In the multivariable model, high-grade VUR (OR=3.28; 95% CI 1.09–9.85; p=0.034), bilaterality (OR=3.05; 95% CI 1.07–8.73; p=0.037), and CAP duration (OR=1.11; 95% CI 1.01–1.22; p=0.022) remained statisti-cally associated with recurrent febrile UTI (Hosmer–Lemeshow p=0.858). Conclusion: High-grade and bilateral VUR were independently associated with recurrent febrile UTI. Longer CAP duration was also associated with recurrence; however, because CAP dura-tion was determined during follow-up and may reflect clinical risk and prior break-through infections, this association should not be interpreted as causal. Patients with high-grade and bilateral VUR may benefit from closer follow-up and individualized management.

Özet

Amaç/Gerekçe: Vezikoüreteral reflülü (VUR) çocuklarda tekrarlayan ateşli idrar yolu enfeksiyonu (İYE), renal skar gelişimi ve uzun dönem morbidite ile ilişkilidir. Bu retrospektif kohort çalışmasının amacı, VUR'lu çocuklarda tekrarlayan ateşli İYE için bağımsız risk faktörlerini belirlemektir. Gereç ve Yöntem: Ocak 2023 ile Mayıs 2026 tarihleri arasında Ankara Etlik Şehir Hastanesi Çocuk Nefrolojisi Kliniği'nde VUR tanısı alan 100 çocuk retrospektif olarak değerlendirildi. Tekrarlayan İYE, izlem süresince iki veya daha fazla ateşli İYE atağı geçirilmesi olarak tanımlandı. Hastalar tekrarlayan İYE varlığına göre iki gruba ayrıldı ve demografik özellikler, VUR derecesi, ateşli İYE öyküsü, DMSA sintigrafisi bulguları, laboratuvar sonuçları ve tedavi özellikleri karşılaştırıldı. Tekrarlayan İYE'nin bağımsız belirleyicileri lojistik regresyon analizi ile değerlendirildi. Bulgular: Tanı anındaki ortanca yaş 36,5 ay (3,25–81,0) olup, hastaların 35'inde (%35) tekrarlayan ateşli İYE gelişti. Yüksek dereceli VUR (p=0,038), bilateral tutulum (p=0,045) ve DMSA'da renal skar varlığı (p=0,012) tekrarlayan İYE ile anlamlı olarak ilişkili bulundu. Ayrıca yaş, tanı yaşı, ilk İYE yaşı ve sürekli antibiyotik profilaksisi (CAP) süresi de tekrarlayan İYE grubunda anlamlı olarak daha yüksekti (tüm p<0,05). Çok değişkenli analizde yüksek dereceli VUR (OR=3,28; %95 GA: 1,09–9,85; p=0,034), bilateral tutulum (OR=3,05; %95 GA: 1,07–8,73; p=0,037) ve CAP süresi (OR=1,11; %95 GA: 1,01–1,22; p=0,022) tekrarlayan İYE için bağımsız risk faktörleri olarak belirlendi (Hosmer–Lemeshow p=0,858). Sonuç: Yüksek dereceli VUR, bilateral tutulum ve daha uzun süreli sürekli antibiyotik profilaksisi, VUR'lu çocuklarda tekrarlayan ateşli İYE için bağımsız risk faktörleridir. Özellikle yüksek dereceli ve bilateral VUR'u olan hastalar daha yakın izlem ve bireyselleştirilmiş tedavi yaklaşımlarından fayda görebilir.

🔖

Cite This Article

Kenan, B. U., Soylu, A. G., Güngör, T., Çakıcı, E. K., Yılmaz, A. Ç. (2026). Risk Factors for Recurrent Urinary Tract Infection in Children with Vesicoureteral Reflux. Çukurova Anestezi ve Cerrahi Bilimler Dergisi, Cilt: 9 Sayı: 3, 1109–1116. https://doi.org/10.36516/jocass.2007248

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (16)

  1. Garcia-Roig ML, Kirsch AJ. Urinary tract infection in the setting of vesicoureteral reflux. F1000Res. 2016;5:F1000 Faculty Rev-1552. doi:10.12688/f1000research.8390.1
  2. Mattoo TK, Mohammad D. Primary vesicoureteral reflux and renal scarring. Pediatr Clin North Am. 2022;69(6):1115-1129. doi:10.1016/j.pcl.2022.07.007
  3. Chen MJ, Cheng HL, Chiou YY. Risk factors for renal scarring and deterioration of renal function in primary vesico-ureteral reflux children: a long-term follow-up retrospective cohort study. PLoS One. 2013;8(2):e57954. doi:10.1371/journal.pone.0057954
  4. Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L, et al. Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics. 2015;136(1):e13-e21. doi:10.1542/peds.2015-0409
  5. Gnech M, 't Hoen L, Zachou A, et al. Update and summary of the European Association of Urology/European Society of Paediatric Urology paediatric guidelines on vesicoureteral reflux in children. Eur Urol. 2024;85(5):433-442. doi:10.1016/j.eururo.2023.12.005
  6. RIVUR Trial Investigators, Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014;370(25):2367-2376. doi:10.1056/NEJMoa1401811
  7. Smellie JM, Jodal U, Lax H, Tamminen-Möbius T, Hirche H, Olbing H; Writing Committee, International Reflux Study in Children (European Branch). Outcome at 10 years of severe vesicoureteric reflux managed medically: report of the International Reflux Study in Children. J Pediatr. 2001;139(5):656-663. doi:10.1067/mpd.2001.117583
  8. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610. doi:10.1542/peds.2011-1330
  9. Mattoo TK, Chesney RW, Greenfield SP, Hoberman A, Keren R, Mathews R, et al. Renal scarring in the randomized intervention for children with vesicoureteral reflux (RIVUR) trial. Clin J Am Soc Nephrol. 2016;11(1):54-61. doi:10.2215/CJN.05210515
  10. Dias CS, Silva JMP, Diniz JSS, Lima EM, Marciano RC, Lana LGSL, et al. Risk factors for recurrent urinary tract infections in a cohort of patients with primary vesicoureteral reflux. Pediatr Infect Dis J. 2010;29(2):139–144. doi:10.1097/inf.0b013e3181b8e85f
  11. Fang H, Yu X, Yu Y, Liu X, Hua Y, Wu S, et al. A novel clinical score to predict breakthrough urinary tract infection in children with VUR: meta-analytic derivation and real-world validation. Pediatr Nephrol. 2026;41:1097-1110. doi:10.1007/s00467-025-07067-8
  12. Ismail K, Moussa M, Aoun B, Abou Chakra M, Kallas-Chemaly A, Yadav P, et al. Development of a prediction model for urinary tract infection risk after open reimplantation in children with primary unilateral vesicoureteral reflux: a multicentre study. BJUI Compass. 2025;6(11):e70111. doi:10.1002/bco2.70111
  13. Bratslavsky G, Feustel PJ, Aslan AR, Kogan BA. Recurrence risk in infants with urinary tract infections and a negative radiographic evaluation. J Urol. 2004;172(4 Pt 2):1610-1613. doi:10.1097/01.ju.0000138522.76908.12
  14. Choi EJ, Lee MJ, Park SA, Lee OK. Predictors of high-grade vesicoureteral reflux in children with febrile urinary tract infections. Child Kidney Dis. 2017;21(2):136-141. doi:10.3339/jkspn.2017.21.2.136
  15. Al Qahtani W, Sarhan O, Al Otay A, El Helaly A, Al Kawai F. Primary bilateral high-grade vesicoureteral reflux in children: management perspective. Cureus. 2020;12(12):e12266. doi:10.7759/cureus.12266
  16. Morello W, Baskin E, Jankauskiene A, Yalcinkaya F, Zurowska A, Puccio G, et al; PREDICT Study Group. Antibiotic prophylaxis in infants with grade III, IV, or V vesicoureteral reflux. N Engl J Med. 2023;389(11):987–997. doi:10.1056/NEJMoa2300161