ESPN 51th Annual Meeting

ESPN 2018


 
Gender differences in small children with urinary tract infection
SVANTE SWERKERSSON 1 EIRA STOKLAND 3 RUNE SIXT 2 SVERKER HANSSON 1

1- DEPARTMENT OF PEDIATICS, THE QUEEN SILVIA CHILDREN´S HOSPITAL, GOTHENBURG, SWEDEN
2- PEDIATRIC CLINICAL PHYSIOLOGY, THE QUEEN SILVIA CHILDREN´S HOSPITAL, GOTHENBURG, SWEDEN
3- PEDIATRIC RADIOLOGY, THE QUEEN SILVIA CHILDREN´S HOSPITAL, GOTHENBURG, SWEDEN
 
Introduction:

Urinary tract infection (UTI) is a common infection among small children. Still, little has been published concerning the impact of gender on the management of UTI. In this study the influence of gender was retrospectively analysed in a population of community acquired first-time UTI.

Material and methods:

1003 children <2 years of age with symptomatic UTI were included. Voiding cystogram was performed in 905 children and DMSA-scintigraphy in 778. The maximum CRP and temperature, bacterial findings and recurrent febrile UTI within 2 years were recorded. Renal damage on DMSA-scintigraphy performed >90 days after UTI was classified as minor if focal defect and differential renal function (DFR) 45%, moderate if DFR 40-44% and pronounced if DFR<40%.

Results:

The study comprised 492 boys and 511 girls with median age 3.4 and 9.3 months (p<0.0001).  The maximum CRP was 50 mg/mL in boys and 73 mg/mL in girls (p<0.0001) and maximum temperature 39.0°C and 39.5°C, respectively (p<0.0001). UTI was caused by Escherichia coli in 437 (89%) boys and in 488 (96%) girls (p<0.0001). Vesico-ureteral reflux (VUR) was found in 72/458 (16%) boys and in 103/447 (23%) girls (p=0.005), mainly because of higher frequency of VUR grade I-II, 27 (6%) and 64 (14%; p<0.0001), respectively. Similar frequency of renal damage was found, 92/378 (24%) in boys and 111/400 (28%) in girls (p=0.28), but renal damage was classified as pronounced more often in boys 24/92 (26%) than in girls 12/111 (11%; p=0.005). Recurrent febrile UTI occurred in 48 (10%) boys and in 71 (14%) girls (p=0.04).

Conclusions:

Gender differences were found concerning age, inflammatory response, bacteriology and frequency of recurrent UTI. Girls had more low-grade VUR and less serious renal damage. These results indicate that boys and girls may need different approaches concerning investigation and treatment.