Background. The treatment and imaging studies of urinary tract infections have evolved over the last decade, creating the need to update and follow the guideline periodically. Objective. To evaluate the impact of the different therapeutic guidelines in the incidence of renal scarring, and to assess the adherence to the evaluations and follow-up visits and to the treatment protocols. Method. Retrospective study of 157 cases diagnosed with urinary tract infection between 2008 and 2010, with evaluation the development of renal scars in the different treatment categories. The data was compared with similar data collected from 1996 to 2005. We determined the failures in follow-up due to lack of compliance or failure to schedule clinic visits and diagnostic studies. Results. Appropriate follow-up was noted in 76 children; 58 cases were treated with cefixime monotherapy. Sequelae were seen in 27.6% of children; 20.68% of children treated with cefixime, 87% of children treated with ampicillin and gentamycin, and 20% of children treated with a sequential treatment. Twenty-seven children did not return for the scheduled Tc99 DMSA scan. Follow-up visits and DMSA scan were not scheduled for 29 children. The incidence rate of renal scarring in the 1996-2005 cohort, in which different guidelines were applied, was 30.6%. Conclusions. The incidence rates of renal scarring were very similar in both cohorts, and in all cases appeared to correlate with time of diagnosis, time of initiation of therapy, and acute-phase reactants. The tendency to rely on the primary care pediatrician to schedule a DMSA scan and follow-up visits rather than applying a strict protocol and scheduling those as part of the initial evaluation and treatment may lead to lack of adherence to the guidelines and incomplete follow-up.
|Publication status||Published - 1 Oct 2011|
- Patient adherence
- Renal scars
- Urinary tract infection