Mp64-17 incidence of febrile urinary tract infection in children with hirschsprung disease is increased in the first months of life

INTRODUCTION AND OBJECTIVES: Dysfunctional voiding patterns are a major risk factors for febrile urinary tract infection (UTI) in children. Patients treated for Hirschprung disease (HD) may present risk factors for UTI: 1) bowel dysfunction with persistent constipation and 2) a postoperative bladder dysfunction due to perineal surgery with damage to nerve supply of the pelvic floor. However, little data is available regarding the HD as a risk factor of febrile UTI. The objective of this study is to find out whether the children with HD are more prone to develop febrile UTI than controls. METHODS: This comparative case-control retrospective study included patients with HD who underwent surgery with diagnosis confirmed at pathologic examination from 2005 to 2016. Controls were selected without any urinary tract disease and were matched for both sex and age at follow-up. Three controls were included per case. RESULTS: 555 children were included (129 patients and 426 controls). There were 108 males (sex ratio= 5,14). The overall incidence of febrile UTI in children with HD was not significantly higher than in controls (3.10% vs 4,22%, p=0,86). Recurrence of UTI was not more frequent in the HD group either (0% vs 0.23%). Neither the length of the bowel segment with HD nor the surgical technique were a significant risk factor for UTI. Since soiling is a sign of severe bowel dysfunction, it was strongly suspected to increase the risk of febrile UTI. However patients with soiling did not have an increased risk of UTI compared to those with normal bowel movement (4.54% vs 1,06%, p=0.61) and to controls (4.54% vs 4.22% p= 0,75). Febrile UTI occurred more frequently during the first 3 months of life in the HD group than in controls (n=4/4 vs n=2/18, p=0.002) and the risk of neonatal UTI is higher (3.1% vs 0.4%, p=0.028) CONCLUSIONS: HD does not increase the overall incidence of febrile UTI but the risk of neonatal UTI is higher in HD patients than in controls. An early optimal bowel management and parental education in the first months of life may be relevant. Source of Funding: declared no conflict of interest