Meta-analysis of the Risk Factors for Urinary Tract Infection in Children.

Abstract

Context:The incidence of urinary tract infection (UTI) varies with age, but there is limited evidence on the role of other risk factors.Objective:The aim of this meta-analysis was to investigate the risk factors for UTIs in children.Data sources:PubMed from 1966 to May 2019.Study selection:All studies assessing at least 1 possible risk factor for occurrence or recurrence of UTI with a clear definition of symptomatic UTI in children were eligible. We excluded studies with UTIs related to hospital treatment or severe congenital renal abnormalities.Data extraction:After the quality assessment we extracted data on the given risk factor in children with and without UTI. The data were extracted separately for the occurrence and recurrence of UTIs.Results:We included 24 studies in the meta-analysis. Circumcision decreased the occurrence of UTIs with an odds ratio (OR) of 0.1 [95% confidence interval (CI): 0.06–0.17) and breast-feeding with an OR of 0.4 (CI: 0.19–0.86), both with low heterogeneity. Being overweight or obese increased the risk of UTI (OR: 2.23; CI: 1.37–3.63). Both poor fluid intake (OR: 6.39; CI: 3.07–13.39) and infrequent voiding (OR: 3.54; CI: 1.68–7.46) were associated with recurrent UTIs.Limitations:The design, populations and definitions varied between the studies.Conclusions:Being overweight or obese and having poor fluid intake are modifiable risk factors that increase the risk for UTIs in children. Breast-feeding and circumcision are associated with a decreased occurrence of UTIs.