Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Experiences with Febrile Infants, Younger than Three Months, with Urinary Tract Infection in a Single Center for Four Years : Incidence, Pathogens and Viral Co-infections

  • Yoon, Seok Ho (Cheil General Hospital & Women's Health Care Center Dankook University College of Medicine) ;
  • Shin, Son Moon (Cheil General Hospital & Women's Health Care Center Dankook University College of Medicine) ;
  • Park, Sung Won (Cheil General Hospital & Women's Health Care Center Dankook University College of Medicine)
  • Received : 2017.09.01
  • Accepted : 2017.09.27
  • Published : 2017.10.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this study was to analyze the incidence and microbiological characteristics of urinary tract infection in infants aged younger three months and to compare with other infection with positive urine culture. Methods: We retrospectively reviewed the medical records of 425 infants with a tympanic temperature >$37.6^{\circ}C$, aged younger than three months, who were admitted to Cheil General Hospital in Seoul, Korea, from January 2013 to December 2016. Demographic and clinical features, laboratory findings, respiratory virus PCR and the pathogens of a urine culture were analyzed. Results: A total of 88 infants (63 males, 25 females) had urinary pathogens detected in the urine culture test. The incidence of UTI in febrile infants aged younger 3 months was 11%. The most common pathogen which causes UTI was E. coli as same as in previous studies. They were divided into a UTI group (n=48) and a non-UTI group (n=40). In comparison of both group, leukocytosis, C-reactive protein level, Absolute neutrophil count level, peak temperature is statistically significant. In both group, there were co-infections with viral pathogens in some cases, and the odd ratio of non-UTI group with viral infection was 3.28. Conclusion: The study determined the incidence and pathogen of UTI in febrile infants, aged younger three months. E. coli was responsible for the majority UTI. There were some viral co-infections in febrile infants with bacteriuria and incidence was higher in non-UTI group. WBC count, ANC count and CRP level were the differentiating factors of UTI from non-UTI group.

Keywords

References

  1. Nelson DS, Walsh K, Fleisher GR. Spectrum and frequency of pediatric illness presenting to a general community hospital emergency department. Pediatrics 1992;90:5-10.
  2. Baraff LJ, Bass JW, Fleisher GR, Klein JO, McCracken GH Jr, Powell KR, Schriger DL. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Ann Emerg Med 1993;22:1198-210. https://doi.org/10.1016/S0196-0644(05)80991-6
  3. Luszczak M. Evaluation and management of infants and young children with fever. Am Fam Physician 2001;64:1219-26.
  4. Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr 1993;123:17-23. https://doi.org/10.1016/S0022-3476(05)81531-8
  5. Miron D, Shatzberg G, Landau D, Halevy R. Treatment of community-acquired urinary tract infections. Israel J Pediatr 2001;38:7-15.
  6. Israeli Central Bureau of Statistics, Statistical Abstracts of Israel, 2005-2009, Data on Beer-Sheva sub-district population.
  7. Ismaili K, Lolin K, Damry N, Alexander M, Lepage P, Hall M. Febrile urinary tract infections in 0- to 3-month-old infants: a prospective follow-up study. J Pediatr 2011;158:91-4. https://doi.org/10.1016/j.jpeds.2010.06.053
  8. Roberts KB, Charney E, Sweren RJ, Ahonkhai VI, Bergman DA, Coulter MP, et al. Urinary tract infection in infants with unexplained fever: a collaborative study. J Pediatr 1983;103:864-7. https://doi.org/10.1016/S0022-3476(83)80702-1
  9. Merrick MV, Notghi A, Chalmers N, Wilkinson AG, Uttley WS. Long-term follow up to determine the prognostic value of imaging after urinary tract infections. Part 2: Scarring. Arch Dis Child 1995;72(5):393-6. https://doi.org/10.1136/adc.72.5.393
  10. Rushton HG. Urinary tract infections in children. Epidemiology, evaluation, and management. Pediatr Clin North Am 1997;44(5):1133-69. https://doi.org/10.1016/S0031-3955(05)70551-4
  11. Urinary Tract Infection : Clinical Practice Guideline for the Diagnosis and Management of the initial UTI in Febrile Infants and Children 2 to 24 Months, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management . Pediatrics 2011;128:595-607. https://doi.org/10.1542/peds.2011-1330
  12. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: A meta-analysis. The Pediatric Infectious Disease Journal 2008;27:302-8. https://doi.org/10.1097/INF.0b013e31815e4122
  13. Liaw LC, Nayar DM, Pedler SJ, Coulthard MG. Home collection of urine for culture from infants by three methods: survey of parents' preferences and bacterial contamination rates. BMJ 2000;320(7245):1312-3. https://doi.org/10.1136/bmj.320.7245.1312
  14. Kang MJ, Shin HK, Yim HE, Je BK, Eun SH, Choi BM, et al. Urinary tract infections in infants under six months of age. Korean J Pediatr 2006;49(3):278-86. https://doi.org/10.3345/kjp.2006.49.3.278
  15. Manucha V, Rusia U, Sikka M, Faridi MM, Madan N. Utility of haematological parameters and C-reactive protein in the detection of neonatal sepsis. J Paediatr Child Health 2002;38(5):459-64. https://doi.org/10.1046/j.1440-1754.2002.00018.x
  16. Dagan R, Powell KR, Hall CB, Menegus MA. Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis. The Journal of Pediatrics 1985;107(6):855-60. https://doi.org/10.1016/S0022-3476(85)80175-X
  17. Anbar RD, Richardson-de Corral V, O'Malley PJ. Difficulties in universal application of criteria identifying infants at low risk for serious bacterial infection. J Pediatr 1986;109(3):483-5. https://doi.org/10.1016/S0022-3476(86)80122-6
  18. Roberts KB. Urinary tract infection treatment and evaluation. Update Pediatr Infect Dis J 2004;23:1163-4.
  19. Marcus N, Ashkenazi S, Yaari A, Samra Z, Livni G. Non-Escherichia coli versus Escherichia coli community-acquired urinary tract infection in children hospitalized in a tertiary center-relative frequency, risk factors, antimicrobial resistance and outcome. Pediatr Infect Dis J 2005;24:581-5. https://doi.org/10.1097/01.inf.0000168743.57286.13
  20. Byington CL, Enriquez FR, Hoff C, Tuohy R, Taggart EW, Hillyard DR, et al. Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections. Pediatrics 2004;113(6):1662-6. https://doi.org/10.1542/peds.113.6.1662
  21. Zorc JJ, Levine DA, Platt SL, Dayan PS, Macias CG, Krief W, et al. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics 2005;116(3): 644-8. https://doi.org/10.1542/peds.2004-1825
  22. Roberts KB, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128(3):595-610. https://doi.org/10.1542/peds.2011-1330
  23. Lee SJ, Guidelines for childhood urinary tract infection. Korean J Pediatr 2009;52:976-83. https://doi.org/10.3345/kjp.2009.52.9.976