Recurrence and Follow-up after Urinary Tract Infection

Kim, Ji Hee; Shin, Hye Kyung; Yoo, Kee Hwan; Hong, Young Sook; Lee, Joo Won; Kim, Soon Kyum

Abstract

PURPOSE
Urinary tract infection(UTI) is the most common bacterial infectious disease that may induce severe renal injury unless early diagnosis and appropriate treatment are performed. If recurrent UTI is prevented, renal injury can be also reduced. Therefore, we studied the risk factors of recurrent UTI in children.
METHODS
We performed a retrospective study of 168 children(58 girls and 110 boys) who were treated for UTI in the Department of Pediatrics, Korea University Medical Center, during 2000-2001. Among 168 children, 93 children were followed up for more than six months. For the detection of recurrence of UTI, we performed monthly routine urine cultures and physical examinations.
RESULTS
The total rate of recurrence was 32.3%. The recurrent rate in boys and girls were 37.1% and 17.4%, respectively(P<0.05). The most common causative bacteria in the first onset and in recurrence were Escherichia coli. There was a significant difference in the onset age of UTI between boys with recurrence(4.8+/-1.0 months) and without recurrence(16.5+/-3.8 months)(P<0.01). In 77% of cases, urinary tract infection recurred within six months of the first infection. The time of the first recurrence after UTI was 3.7+/-0.6 months in boys and 14+/-8.2 months in girls(P<0.01). The number of recurrences showed a significant difference between the group under the age of one year(0.69+/-0.8/year) and those above the age of one year(0.16+/-0.4/year)(P<0.05). There was no difference in the recurrent rate between those with structural abnormality and those with normal anatomy.
CONCLUSION
Monthly routine urine cultures are efficient in detecting recurrent UTI in children. Because the male sex and young age especially less than one year of age are risk factors for increased recurrence rate of UTI, these children should be followed-up with urine cultures.