MP64-07 REVISITING RISK FACTORS FOR FEBRILE URINARY TRACT INFECTION USING A LARGE PRENATAL HYDRONEPHROSIS DATASET

Abstract

INTRODUCTION AND OBJECTIVES: Risk factors for febrile UTI (fUTI) in infants with prenatal hydronephrosis (HN), such as female gender, uncircumcised status, high grade HN and non-refluxing primary megaureter (NRPM) have been consistently documented in several small sample size series, however the same cannot be said regarding continuous antibiotic prophylaxis (CAP). Herein, we revisit this clinically important outcome using a large single center database to confirm or refute these previous findings. METHOD(S): Since 2009, we have prospectively followed 876 consecutive prenatal HN infants <12 months of age with the following conditions: UPJO-like, non-refluxing primary megaureter (NRPM) and VUR. Patients with <6months F/U were excluded. A priori collected variables included: HN SFU grade (low-I/II vs. high-III/IV), HN etiology, CAP, gender and circumcision status. Primary outcome was catheter specimen fUTI. Time to event curves (Hazard ratio-HR) were analyzed by Cox proportional regression to adjust for confounders. Analyses were done with and without VUR patients. RESULT(S): Of 848 included patients, 632 (75%) were male and 36% were circumcised. 73 (9%) had a fUTI at a median age of 6 months (IQR 9). Mean follow-up was 30 months (6-120). High grade HN was seen in 467 (55%) infants and CAP prescribed for 450 (53%). VUR (68% grades IV-V) was detected in 168/572 (29%) patients who had a VCUG. Upon univariate analysis, a significantly higher fUTI rate was seen in females, uncircumcised males, patients with NRPM and high grade HN (Table 1). In the Cox proportional regression model, NRPM (HR=4.8, p<0.01), VUR (HR=7.0, p<0.01), uncircumcised males (HR=2.3, p=0.03), females (HR=2.5, p=0.02), and lack of CAP (HR=3.7, p<0.01), were significantly associated with fUTI (Table 2). HN grade was not found to be associated with fUTI. KM curves for fUTI risk factors are shown in Fig. 1. CONCLUSION(S): This study validates previous findings, confirming NRPM, VUR, uncircumcised status and female gender as important risk factors for fUTI. According to our large dataset analysis, CAP significantly reduced fUTIs and should be offered to these high-risk HN patients.