Delay in Antibiotic Treatment for UTIs and Renal Scarring

Abstract

Research Article| October 01 2016 Delay in Antibiotic Treatment for UTIs and Renal Scarring AAP Grand Rounds (2016) 36 (4): 38. https://doi.org/10.1542/gr.36-4-38 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Delay in Antibiotic Treatment for UTIs and Renal Scarring. AAP Grand Rounds October 2016; 36 (4): 38. https://doi.org/10.1542/gr.36-4-38 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: renal scarring, urinary tract infections, fever Source: Shaikh N, Mattoo TK, Keren R, et al. Early antibiotic treatment for pediatric febrile urinary tract infection and renal scarring [published online ahead of print July 25, 2016]. JAMA Pediatr; doi: https://doi.org/10.1001/jamapediatrics.2016.1181 Investigators at multiple institutions conducted a retrospective cohort study of data from 2 previous longitudinal studies (the Randomized Intervention for Children With Vesicoureteral Reflux [RIVUR] trial and the Careful Urinary Tract Infection Evaluation [CUTIE] Study) to determine whether delay in the initiation of antimicrobial treatment for febrile urinary tract infection (UTI) is associated with the occurrence of renal scarring in children. Participants in the RIVUR and CUTIE studies were 2 to 72 months old, presented for their first or second UTI at primary or subspecialty care settings, and were prospectively followed up for 2 years. The RIVUR study enrolled children with vesicoureteral reflux (VUR), while the CUTIE study enrolled children without VUR. Parents of participants in each study were asked at enrollment about the duration of their child’s fever before antimicrobial therapy for the index UTI was started. Children in both studies also received a technetium Tc 99m DMSA renal scan at baseline and at either the 24-month follow-up appointment or several months after being withdrawn from the study due to recurrent UTIs. The primary exposure variable was delay in the initiation of antimicrobial therapy, defined as parent self-reported duration of time between the onset of fever and the start of antimicrobial therapy. The primary outcome was new renal scarring, defined as the presence of areas of photopenia plus contour changes on the follow-up DMSA scan that were not present on the baseline scan. Logistic regression was used to determine the association of delay in initiating antimicrobial therapy and new renal scarring after adjusting for potential confounding variables. Of the 802 participants in the RIVUR and CUTIE studies, 482 were included in analysis. Among included participants, 90% were female, 78% were white, 7% had new renal scarring, and the median number of hours to initiation of antimicrobial therapy was 56.3 hours. Participants with new renal scarring had a significantly longer median time to initiation of antimicrobial therapy than those without new renal scarring (72 vs 48 hours, respectively; P = .003). Older age, Hispanic ethnicity, recurrent UTIs, and bladder and bowel dysfunction were also associated with new renal scarring. The association between delay in the initiation of antibiotic therapy and renal scarring remained statistically significant after adjusting for these other variables. The researchers conclude that there is an association between a delay in the initiation of antibiotic treatment and renal scarring. Dr. Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. This study demonstrated that a delay of >48 hours in initiating antibiotics for a UTI increases the odds of renal scarring. Strengths of this study are its longitudinal follow-up of children for 2 years and its comparison of baseline and late DMSA scans for... You do not currently have access to this content.