A predictive score for detecting vesicoureteral reflux in children with their first Escherichia coli-induced urinary tract infection

Objectives: In children with a first Escherichia coli-induced febrile urinary tract infection (fUTI), routine voiding cytourethrography (VCUG) is not recommended for detecting vesicoureteral reflux (VUR). Meanwhile, the sensitivity of renal and bladder ultrasound (RBUS) for detecting VUR is insufficient. Aiming to implement VCUG properly for children with a first E. coli-induced fUTI, we attempted to construct a predictive scoring system for the early screening of VUR. Methods: This study enrolled patients aged <2 years of age hospitalized for their first E. coli-induced fUTI during the period when VCUG was implemented for all patients (2007–14, non-selective group [n = 111]) and only for those with VUR-suspected RBUS findings, bacteremia or acute focal bacterial nephritis (2016–19, selective group [n = 102]). We evaluated the accuracy of the current criteria and the VUR predictive score constructed using data from the non-selective group. Results: In the non-selective group, 32 patients had VUR (29%). In the selective group, 20 of 45 VCUG-tested patients had VUR (44%). Among 57 patients not undergoing VCUG in the selective group, 8 had a recurrence of fUTI, 3 of whom were diagnosed with VUR. In the non-selective group, 9 patients with VUR did not fulfill the current criteria and the VUR predictive score consisting of young age, female sex, prolonged fever, hypoproteinemia, hyponatremia and hyperglycemia, showed higher sensitivity, specificity than the current criteria. Conclusions: The current imaging/bacteriological criteria were ineffective in screening for VUR in patients with their first E. coli-induced fUTI. The VUR predictive score can be an accurate indicator for implementing VCUG.