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Antibiotics within 48h prevent renal scarring

September 7, 2016

Short Attention Span Summary

This is pretty “scarry.”
The longer a child has fever from pyelonephritis, the greater the renal scarring on follow up nuclear scans.

Spoon Feed = Two days
Initiation of antibiotics within a median of 48 hours was not associated with scarring, but a delay of 72 hours was.

Following AAP guidelines, if you have a febrile child with no localizing signs, check a urinalysis.
I check all boys <12 months if uncircumcised, <6 months if circumcised.  I check girls <36 months.  This is from the classic Baraff article.


JAMA Pediatr. 2016 Jul 25. doi: 10.1001/jamapediatrics.2016.1181. [Epub ahead of print]

Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring.

Shaikh N1, Mattoo TK2, Keren R3, Ivanova A4, Cui G5, Moxey-Mims M6, Majd M7, Ziessman HA8, Hoberman A1.

Author information:

1University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania.

2Wayne State University, Children’s Hospital of Michigan, Detroit.

3Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania4Associate Editor, JAMA Pediatrics.

4Department of Biostatistics, University of North Carolina at Chapel Hill.

5Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill.

6National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.

7George Washington University School of Medicine, Children’s National Medical Center, Division of Radiology, Washington, DC.

8Department of Radiology, Johns Hopkins University, Baltimore, Maryland.



Existing data regarding the association between delayed initiation of antimicrobial therapy and the development of renal scarring are inconsistent.


To determine whether delay in the initiation of antimicrobial therapy for febrile urinary tract infections (UTIs) is associated with the occurrence and severity of renal scarring.

Design, Setting, and Participants:

Retrospective cohort study that combined data from 2 previously conducted longitudinal studies (the Randomized Intervention for Children With Vesicoureteral Reflux trial and the Careful Urinary Tract Infection Evaluation Study ). Children younger than 6 years with a first or second UTI were followed up for 2 years.


Duration of the child’s fever prior to initiation of antimicrobial therapy for the index UTI.

Main Outcomes and Measures:

New renal scarring defined as the presence of photopenia plus contour change on a late dimercaptosuccinic acid renal scan (obtained at study exit) that was not present on the baseline scan.


Of the 482 children included in the analysis, 434 were female (90%), 375 were white (78%), and 375 had vesicoureteral reflux (78%). The median age was 11 months. A total of 35 children (7.2%) developed new renal scarring. Delay in the initiation of antimicrobial therapy was associated with renal scarring; the median (25th, 75th percentiles) duration of fever prior to initiation of antibiotic therapy in those with and without renal scarring was 72 (30, 120) and 48 (24, 72) hours, respectively (Pā€‰=ā€‰.003). Older age (OR, 1.03; 95% CI, 1.01-1.05), Hispanic ethnicity (OR, 5.24; 95% CI, 2.15-12.77), recurrent urinary tract infections (OR, 0.97; 95% CI, 0.27-3.45), and bladder and bowel dysfunction (OR, 6.44; 95% CI, 2.89-14.38) were also associated with new renal scarring. Delay in the initiation of antimicrobial therapy remained significantly associated with renal scarring even after adjusting for these variables.

Conclusions and Relevance:

Delay in treatment of febrile UTIs and permanent renal scarring are associated. In febrile children, clinicians should not delay testing for UTI.

PMID: 27455161 [PubMed – as supplied by publisher]

What are your thoughts?