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ABSTRACT
Background.
Major urinary tract abnormalities are detected in 20 to 40% of
infants with acute pyelonephritis (APN). Early detection of
structural defects is essential for protecting the kidneys from
reinfection and subsequent scarring. The purpose of this study was
to investigate whether any factors present during the acute phase of
infection could predict the presence of existing significant urinary
tract abnormalities in infants.
Methods. A prospective study of 180
infants, aged 1 to 24 months, with APN was conducted.
Blood and urine samples were
collected. Renal ultrasound(US) was performed within 0 to 6 days
from admission. Final diagnosis of the urinary tract anatomy was
elucidated using the results of two or more radiologic imaging
studies.
Results. Risk factors for the
presence of significant urinary tract abnormalities in infants were
pathogens other than Escherichia coli in urine [relative risk (RR)
3.4, 95% confidence interval (CI) 2.2 to 5.3; P=0.001] , positive
blood culture (RR 2.3, 95% CI 1.3 to 4.0;P=0.039), young age(1 to 6
months) (RR 2.2,95% CI 1.3 to 3.9;P=0.004), lack of papG adhesin
genes of E. coli in urine(RR 2.1,95% CI 1.2 to 3.9;P=0.016) and
abnormal renal US(RR2.0,95%CI 1.2 to 3.4;P=0.008).
Conclusions. Infants 1 to 6 months
of age with APN caused by bacteria other than E. coli or by
papG-negative E. coli strain, positive blood culture and abnormal
renal US carry an increased risk for significant urinary tract
abnormalities and need enforced follow-up.
Pediatr Infect Dis J, 2001;20:597-601
Copyright 2001 by Lippincott Williams &Wilkins,Inc. | 
