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Characteristics of First Urinary Tract Infection With Fever in Children: A Prospective Clinical and Imaging Study

Ismaili Khalid et al. - Girls represent 63% of cases with first urinary tract infection (UTI). For 91% of UTIs, Escherichia coli is held responsible with a high rate of resistance to ampicillin and trimethoprim/sulfamethoxazole. US is an excellent screening tool that allows avoidance of unjustified voiding cystourethrography studies.

Methods
  • The authors prospectively followed (median, 20 months) 209 children treated for first febrile UTI.
  • Renal ultrasound (US) and voiding cystourethrography examinations were performed in all patients.

Results
  • Among the children, 63% were females and 37% were males, and 75% of them had their first UTI before the age of 2 years.
  • The most common causative agent was Escherichia coli (91% of cases) with high rate resistance to ampicillin (58%) and trimethoprim/sulfamethoxazole (38%).
  • Of these children, 25% had evidence of VUR (15 boys and 38 girls). VUR was of low grade in 85% of cases.
  • The overall performance of renal US as a diagnostic test to detect significant uropathies excluding low-grade vesicoureteral reflux (VUR) was excellent; the sensitivity attained 97% and the specificity 94%.
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