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

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.

Keywords

• child
• urinary tract infections
• vesicoureteral reflux

Supporting Institution

The authors received no financial support for this study.

Project Number

Not Applicable (N/A)

Ethical Statement

Ethics Statement: This study was approved by the Ethics Committee of Ankara Etlik City Hospital (Approval No: AEŞH-BADEK2-562, Date: 14 July 2026). The study was conducted in accordance with the principles of the Declaration of Helsinki. Due to the retrospective nature of the study, the requirement for informed consent was waived by the Ethics Committee.

Thanks

The authors declare that there are no acknowledgements.

VUR Tanılı Hastalarda Tekrarlayan İYE için Risk Faktörleri

Abstract

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.

Keywords

• çocuk
• idrar yolu enfeksiyonu
• vezikoüreteral reflü

Supporting Institution

Bu çalışma için herhangi bir kurum veya kuruluştan mali destek alınmamıştır.

Project Number

Not Applicable (N/A)

Ethical Statement

Bu çalışma Ankara Etlik Şehir Hastanesi Klinik Araştırmalar Etik Kurulu'nun 14 Temmuz 2026 tarihli ve EAŞH-BADEK2 -562 sayılı kararı ile onaylanmıştır. Çalışma Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür. Retrospektif çalışma olması nedeniyle bilgilendirilmiş gönüllü olurundan etik kurul tarafından muafiyet verilmiştir.

Thanks

Teşekkür bulunmamaktadır.

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