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Background <p>Urinary tract infections (UTIs) among infants ≤ 3 months old are associated with a high risk of recurrence and renal scarring, yet evidence identifying high-risk infants remains limited. We aimed to identify predictors of UTI recurrence and factors associated with renal scarring in this population.</p> Methods <p>A retrospective chart review was conducted on febrile infants ≤ 3 months at a tertiary paediatric hospital in Singapore, between January 2018 and June 2023. We defined recurrence as any episode occurring within 1 year of the index UTI and renal scarring based on the Technetium-99&#xa0;m 2,3-dimercapto-succinic-acid (DMSA) scan. Multivariable logistic regression was performed to predict for UTI recurrence and renal scarring, using covariates selected a priori. We presented the adjusted odds ratio (aOR) with corresponding 95% confidence interval (95%CI).</p> Results <p>Among 401 infants (median age: 49 days [28–70]; 76% male), 49 (12.2%) experienced recurrent UTI. Male sex (aOR = 2.80, 95%CI:1.14–8.46, <i>p</i> = 0.041) and ultrasound kidney, ureter, and bladder (US KUB) abnormalities (aOR = 2.72, 95%CI:1.40–5.27, <i>p</i> &lt; 0.05) independently predicted recurrence. Among 161 infants with DMSA performed, 21 (13.0%) developed renal scarring. Scarring was associated with bacteraemia (OR = 4.38, 1.54–12.05, <i>p</i> &lt; 0.05), elevated procalcitonin ≥ 0.5 ug/L (OR = 16.82, 4.53-109.39, <i>p</i> &lt; 0.001), non-E.coli uropathogen (OR = 6.18, 2.37–17.49, <i>p</i> &lt; 0.001), hydronephrosis (OR = 3.04, 1.17–7.87, <i>p</i> &lt; 0.05), and vesicoureteral reflux (VUR) (OR = 18.70, 4.31-133.32, <i>p</i> &lt; 0.001), particularly high-grade severity ≥ 3 (OR = 25.50, 5.74-185.47, <i>p</i> &lt; 0.001). Additionally, multivariable analysis identified US KUB abnormalities (aOR = 3.00, 1.57–5.73, <i>p</i> &lt; 0.001) as an independent predictor of renal scarring.</p> Conclusion <p>We reported independent predictors of UTI recurrence and risk factors for renal scarring. These patients should receive more intensive monitoring after their index UTI.</p>

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Predictors of recurrence and renal scarring post-urinary tract infection among young febrile infants

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  • 发表日期：

    2025年11月27日

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  • Koei Wan Tham,
  • Ian Yi En Ong,
  • Hui Chee Tan,
  • Siew Le Chong,
  • Rupini Piragasam,
  • Lena Wong,
  • Zi Xean Khoo,
  • Gene Yong-Kwang Ong,
  • Sashikumar Ganapathy,
  • Shu-Ling Chong

摘要

Background

Urinary tract infections (UTIs) among infants ≤ 3 months old are associated with a high risk of recurrence and renal scarring, yet evidence identifying high-risk infants remains limited. We aimed to identify predictors of UTI recurrence and factors associated with renal scarring in this population.

Methods

A retrospective chart review was conducted on febrile infants ≤ 3 months at a tertiary paediatric hospital in Singapore, between January 2018 and June 2023. We defined recurrence as any episode occurring within 1 year of the index UTI and renal scarring based on the Technetium-99 m 2,3-dimercapto-succinic-acid (DMSA) scan. Multivariable logistic regression was performed to predict for UTI recurrence and renal scarring, using covariates selected a priori. We presented the adjusted odds ratio (aOR) with corresponding 95% confidence interval (95%CI).

Results

Among 401 infants (median age: 49 days [28–70]; 76% male), 49 (12.2%) experienced recurrent UTI. Male sex (aOR = 2.80, 95%CI:1.14–8.46, p = 0.041) and ultrasound kidney, ureter, and bladder (US KUB) abnormalities (aOR = 2.72, 95%CI:1.40–5.27, p < 0.05) independently predicted recurrence. Among 161 infants with DMSA performed, 21 (13.0%) developed renal scarring. Scarring was associated with bacteraemia (OR = 4.38, 1.54–12.05, p < 0.05), elevated procalcitonin ≥ 0.5 ug/L (OR = 16.82, 4.53-109.39, p < 0.001), non-E.coli uropathogen (OR = 6.18, 2.37–17.49, p < 0.001), hydronephrosis (OR = 3.04, 1.17–7.87, p < 0.05), and vesicoureteral reflux (VUR) (OR = 18.70, 4.31-133.32, p < 0.001), particularly high-grade severity ≥ 3 (OR = 25.50, 5.74-185.47, p < 0.001). Additionally, multivariable analysis identified US KUB abnormalities (aOR = 3.00, 1.57–5.73, p < 0.001) as an independent predictor of renal scarring.

Conclusion

We reported independent predictors of UTI recurrence and risk factors for renal scarring. These patients should receive more intensive monitoring after their index UTI.