Urinary tract infection in infants: the significance of low bacterial count
- 1.5k Downloads
In national guidelines for urinary tract infection (UTI) in children, different cut-off levels for defining bacteriuria are used. In this study, the relationship between bacterial count in infant UTI and inflammatory parameters, frequency of vesicoureteral reflux (VUR), kidney damage, and recurrent UTI was analyzed.
We conducted a population-based retrospective study of 430 infants age <1 year with symptomatic UTI diagnosed by suprapubic aspiration. Clinical and laboratory parameters, findings on voiding cystourethrography and 99mtechnetium dimercapto-succinic acid scintigraphy, and frequency of recurrence were related to bacterial count at the index UTI.
Eighty-three (19 %) infants had bacterial counts <100,000 colony-forming units (CFU)/ml and 347 (81 %) had ≥100,000 CFU/ml. There was similar frequency of VUR (19 % in both groups), kidney damage (17 and 23 %, p = 0.33) and recurrent UTI (6 and 12 %, p = 0.17) in the low and high bacterial group. Non-E. coli species were more prevalent (19 versus 6 %, p = 0.0006) and mean C-reactive protein was lower (50 vs. 79 mg/l, p <0.0001) in the low bacteria group.
UTI with low bacterial count is common and of importance since it may be associated with VUR and renal damage. Non-E. coli species and low inflammatory response were more prevalent in UTI with low bacterial count.
KeywordsUrinary tract infection Bacterial count Vesicoureteral reflux Kidney damage Children Infants
Conflict of interest
The authors declare no conflicts of interest.
The study was approved by the Regional Ethical Review Board in Gothenburg (278-08).
- 11.Etoubleau C, Reveret M, Brouet D, Badier I, Brosset P, Fourcade L, Bahans C, Garnier F, Blanc P, Guigonis V (2009) Moving from bag to catheter for urine collection in non-toilet-trained children suspected of having urinary tract infection: a paired comparison of urine cultures. J Pediatr 154:803–806PubMedCrossRefGoogle Scholar
- 12.National Institute for Health and Clinical Excellence (Nice) Guideline (2007) Urinary tract infection in children: diagnosis, treatment and long-term management. Issue date: August, 2007. Available at: http://www.nice.org.uk/guidance/cg54, last accessed April 22, 2015
- 13.Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management (2011) 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 128:595–610CrossRefGoogle Scholar
- 14.Ammenti A, Cataldi L, Chimenz R, Fanos V, La Manna A, Marra G, Materassi M, Pecile P, Pennesi M, Pisanello L, Sica F, Toffolo A, Montini G, Italian Society of Pediatric Nephrology (2012) Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Paediatr 101:451–457PubMedCrossRefGoogle Scholar
- 16.AFSSAPS. Diagnostic et antibiothérapie des infections urinaires bactériennes communautaires du nourrisson et de l’enfant (2007) Available at: http://www.infectiologie.com/site/medias/_documents/consensus/afssaps-inf-urinaires-enfant-reco.pdf, last accessed April 22, 2015
- 18.Robinson JL, Finlay JC, Lang ME, Bortolussi R, Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Community Paediatrics Committee (2014) Urinary tract infections in infants and children: Diagnosis and management. Paediatr Child Health 19:315–325PubMedPubMedCentralGoogle Scholar
- 25.Whiting P, Westwood M, Bojke L, Palmer S, Richardson G, Cooper J, Watt I, Glanville J, Sculpher M, Kleijnen J (2006) Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model. Health Technol Assess 10:1–154PubMedGoogle Scholar