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Archives de pédiatrie
Volume 18, n° 9
pages 955-961 (septembre 2011)
Doi : 10.1016/j.arcped.2011.06.005
Received : 17 January 2011 ;  accepted : 10 June 2011
Comparaison de deux protocoles de prise en charge des infections urinaires fébriles de l’enfant
Comparison of two protocols of febrile urinary tract infection management in children

T. Blanchais a, A. Legrand a, E. Allain Launay a, M.-D. Leclair b, J. Caillon c, G. Roussey-Kesler a,
a Clinique médicale pédiatrique, hôpital Mère–Enfant, CHU de Nantes, 7, Quai-Moncousu, 44093 Nantes cedex, France 
b Service de chirurgie pédiatrique, CHU de Nantes, 7, Quai-Moncousu, 44093 Nantes cedex, France 
c Département de bactériologie, CHU de Nantes, 7, Quai-Moncousu, 44093 Nantes cedex, France 

Auteur correspondant.

Comparer 2 protocoles de prise en charge d’une première infection urinaire (IU) fébrile pour le reflux vésico-urétéral (RVU) de haut grade et pour le coût.

Patients et méthodes

Étude menée chez des enfants de moins de 16ans, consultant pour une première IU fébrile. La première cohorte (2005) a été prise en charge selon les anciennes recommandations (traitement intraveineux et cystographie pour tous les enfants<3ans). La seconde cohorte (2006) a eu une prise en charge stratifiée selon l’âge et le taux de procalcitonine (PCT).


Le nombre d’enfants inclus a été de 225 en 2005 et 116 en 2006. Il n’y avait pas de différence significative en terme de diagnostic de RVU de haut grade (6,2 % des enfants en 2005 et 9,5 % en 2006, p =0,274) et de récidive (5,3 % en 2005 et 8,6 % en 2006, p =0,237). Le coût moyen de prise en charge n’était pas différent (2235€ en 2005, 2256€ en 2006, p =0,902). Pour les enfants de plus de 6 mois, on notait un coût moyen inférieur en 2006 (1882€ en 2005 versus 1292€ en 2006, p =0,0042).


Le protocole stratifié selon l’âge et le taux de PCT ne semble pas sous-estimer le dépistage des RVU de haut grade. Le coût de prise en charge pour les enfants de plus de 6 mois a pu être significativement diminué en 2006. La prise en charge d’une première IU fébrile est discutée.

The full text of this article is available in PDF format.

To compare two first febrile urinary tract infection (UTI) management protocols with regards to the diagnosis of high-grade vesicoureteral reflux (VUR) and cost.


This study compared two cohorts of children under 16 years of age, admitted for a first episode of febrile UTI. The first group (in 2005) was managed according to previous recommendations (IV treatment and cystography performed for all children under 3 years of age). The second group (in 2006) was managed according to age and procalcitonin level. High-grade VUR frequency, UTI recurrence, hospitalization rate, and cost were compared between the two cohorts.


A total of 225 children were included in 2005 and 116 in 2006. High-grade VUR was found in 6.2 and 9.5% of the patients in 2005 and 2006, respectively (P =0.274). There was no statistically significant difference in the UTI recurrence rate between the two cohorts (5.3% in 2005 and 8.6% in 2006; P =0.237). The mean cost of an episode of febrile UTI was not significantly different in 2005 and 2006 (€2235 in 2005, €2256 in 2006; P =0.902), but was lower for children older than 6 months in 2006 (€1292 versus €1882 in 2005; P =0.0042).


Our management protocol for a first febrile UTI episode in children based on procalcitonin levels seems to be suitable for the diagnosis of high-grade VUR. The hospitalization rate and the mean cost of management for children older than 6 months of age was significantly reduced in 2006. The management guidelines for a first occurrence of febrile UTI in children should be reconsidered.

The full text of this article is available in PDF format.

 Ce travail n’a pas reçu d’aide financière.

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