Association of Lewis blood group phenotypes with urinary tract infection in children Barbara A. Jantausch, MD, Valli R. Criss, BS, MT(ASCP) SBB, Regina O'Donnell, MS, Bernhard L. Wiedermann, MD, Massoud Majd, MD, H. Gil Rushton, MD, R. Sue Shirey, MS, MT(ASCP) SBB,and Naomi L. C. Luban, MD From the Departments of Infectious Diseases, Laboratory Medicine, Biostatistics, Radiology (Nuclear Medicine), and Urology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, D.C., and Johns Hopkins Hos- pital, Baltimore, Maryland Many blood group antigens, genetically controlled carbohydrate molecules, are found on the surface of uroepithelial cells and may affect bacterial adher- ence and increase the frequency of urinary tract infection (UTI) in adults. Sixty- two children aged 2 weeks to 17 years (mean, 2.3 years) who were hospitalized with fever in association with UTIs caused by Escherichia coli had complete (n = 50) or partial (n = 12) erythrocyte antigen typing to determine the role of erythrocyte antigens and phenotypes in UTI in children; 62 healthy children un- dergoing nonurologic elective surgery, matched I to I for age, sex, and race to the patient group, formed the control group. In univariate tests, patients and control subjects did not differ in ABO, Rh, P, Kell, Duffy, MNSs, and Kidd systems by the McNemar test of symmetry (p >0.05). The frequency of the Lewis (Le) (a-b -) phenotype was higher (16/50 vs 5/50; p = 0.0076) and the frequency of the Le(a + b +) phenotype was lower (8/50 vs 16/50; p = 0.0455) in the patient population than in the control subjects. A stepwise logistic regression model to predict UTI with the explanatory variables A, B, O, M, N, S, s, Ph Lea, and Le b showed that only the Lea and Leb antigens entered the model with p <0.1. The Le(a-b-) phenotype was associated with UTI in this pediatric population. The relative risk of UTI in children with the Le(a-b-) phenotype was 3.2 (95% con- fidence interval, 1.3 to 7.9). Specific blood group phenotypes in pediatric pop- ulations may provide a means to identify children at risk of having UTI. (J PEDIATR 1994;124"863-8) Urinary tract infection occurs in 3% of girls and 1% of boys, and can result in pyelonephritis and renal scarring, j The binding of bacteria to urinary tract epithelial cells is an im- portant step in the development of UTI. 2 Many blood group antigens are genetically controlled carbohydrate molecules Submitted for publication Oct. 27, 1993; accepted Dec. 30, 1993. Reprint requests: Barbara Jantausch, MD, Department of Infec- tious Diseases, Children's National Medical Center 111 Michigan Ave., N.W., Washington, DC 20010 Copyright | 1994 by Mosby-Year Book, Inc. 0022-3476/94/$3.00 + 0 9/20/54100 and are present on the surface of uroepithelial cells; these carbohydrate molecules influence the attachment of bacte- DMSA Dimercaptosuccinic acid EDTA Ethylenediaminetetraacetic acid Lea Lewis a Leb Lewis b Se Secretor UTI Urinary tract infection ria by acting as receptors for bacteria or by covering exposed receptor sites. 3-5 Predisposition to both acute and recurrent UTIs has been associated with the presence or absence of 863