Meta-analysis of the Risk Factors for Urinary Tract Infection in Children

Context: The incidence of urinary tract infection (UTI) varies with age, but there is limited evidence on the role of other risk factors. Objective: The aim of this meta-analysis was to investigate the risk factors for UTIs in children. Data sources: PubMed from 1966 to May 2019. Study selection: All studies assessing at least 1 possible risk factor for occurrence or recurrence of UTI with a clear definition of symptomatic UTI in children were eligible. We excluded studies with UTIs related to hospital treatment or severe congenital renal abnormalities. Data extraction: After the quality assessment we extracted data on the given risk factor in children with and without UTI. The data were extracted separately for the occurrence and recurrence of UTIs. Results: We included 24 studies in the meta-analysis. Circumcision decreased the occurrence of UTIs with an odds ratio (OR) of 0.1 [95% confidence interval (CI): 0.06–0.17) and breast-feeding with an OR of 0.4 (CI: 0.19–0.86), both with low heterogeneity. Being overweight or obese increased the risk of UTI (OR: 2.23; CI: 1.37–3.63). Both poor fluid intake (OR: 6.39; CI: 3.07–13.39) and infrequent voiding (OR: 3.54; CI: 1.68–7.46) were associated with recurrent UTIs. Limitations: The design, populations and definitions varied between the studies. Conclusions: Being overweight or obese and having poor fluid intake are modifiable risk factors that increase the risk for UTIs in children. Breast-feeding and circumcision are associated with a decreased occurrence of UTIs.