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Low bacterial count urinary tract infections in infants and young children

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The purpose of the study was to compare bacterial species, clinical, laboratory and imaging findings (99m Tc-dimercaptosuccinic acid renal scan and voiding cystogram) in infants and children with high (≥105 colony forming units (CFU)/ml, group A patients) and low (≤5×104 CFU/ml, group C patients) bacterial count in urine cultures during first episode of urinary tract infection. Group B included patients with intermediate CFU/ml. Included were 419 symptomatic patients with: (a) no previous antibiotic treatment, (b) urine samples for quantitative cultures taken by bladder catheterisation or suprapubic bladder aspiration, (c) growth of only one microorganism, and (d) age ≤54 months (age of the oldest patient of group C). Out of 419 cultures, Escherichia coli grew in 315 (75.2%), gram-negative bacteria except E. coli in 91 (21.7%) and gram-positive in 13 (3.1%). Group C patients were significantly ( P <0.0001) more often affected with gram-negative pathogens except E. coli than group A patients (21/44 versus 67/360). Most of group C patients were younger than 24 months of age; none was older than 54 months. Comparison of the prevalence of clinical and laboratory (leucocyte count, CRP, ESR) findings between groups A and C showed no significant differences. There was no statistically significant difference in the prevalence of pyelonephritis, reflux and urological malformations (except reflux) between groups A and C. Conclusion: Low bacterial count urinary tract infections mainly affect infants and young children and are often due to gram-negative bacteria other than E. coli. Clinical and laboratory findings, prevalence of pyelonephritis, reflux and urological malformations are similar in high and low bacterial count urinary tract infections.

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colony forming units


high-power field


suprapubic bladder aspiration

99m Tc-DMSA :

99m Tc-dimercaptosuccinic acid


urinary tract infection


voiding cystourethrography


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Correspondence to Dimitris A. Papanastasiou.

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Kanellopoulos, T.A., Vassilakos, P.J., Kantzis, M. et al. Low bacterial count urinary tract infections in infants and young children. Eur J Pediatr 164, 355–361 (2005).

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