Epidemiología de las infecciones del tracto urinario en niños y riesgo de recurrencia y alteraciones nefrourológicas

From march 1992 to february 1993, the Ministry of Health of Chile sponsored a program intended to improve medical core and gather epidemiologic information on urinary trcct infections in the pediatric population served by the Northern Sarriago Metropolitan Health Service |SSMM}. During this period, suspicious cases of urinary tract infections (UTI) presenting at seven lout or 14] ambulatory care centers and at the local pediatric hospital emergency room were refered to a special unit [U I clinic] ot that same hospital, where diagnoses were confirmed and patients were treated and followed by a standard protocol, including renal ultrasonogram and voiding cystourefhrography to all patients without previous radiologic evaluation. By the time of this study the SSMN cared for 188 329 children [age under 15 years), 108 221 of 'hem were adscribed to the participating health centers, and 1 .275 patients were referred to the UTI clinic, 630 being confi'rned UTI cases. The attack rate of the disease was significantly higher in the participating healtn centers [3-7/1.000), thar, /n the non participating ones (2.7/1 .000, p < 0.0003). Acute pyelonephritis was significantly more ccnmon in children under 24 months of age then among other ages: OR=3.3 [IC95%-2.1-5.3); p < 0.0000001. E. co'ii was the predorrvnant bacterial pathogen in males and females, but identification of non E. coll bacteriae was significantly more frequent among male patients (OR - 17,3; (1C 95% = 8.0 - 38.0). Five hundred and twenty two children were followed beyond recover/ of the index UTI and 148 had at least a second episode of UTI during the fo.low-jp period [1 to 18 months, median and mode 6 months); 87,8% of the detected recurrences occurred before the seventh month of follow-up. Age 24 to 71 months and non E. coll infections were associated with significan-ly higher risk of recurrences: OR = 2.5; (1C 95% - 1.5-4.0) and OR - 2,5 (!C 95% = 1,2-5,2), respectively. Male parents and those with acute pyelonephitis were at significantly higher risk of bearing morphologic abnormalities: OR = 2,0; (1C 95% = 1,03-3,9), and OR = 2,0; (1C 95% = 1,2-3,5).