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The predictive utility of prior positive urine culture in children with recurrent urinary tract infections

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Abstract

Urinary tract infections can cause renal damage if not treated promptly. The aim of this study was to examine if prior urine cultures can predict antibiotic susceptibility profile in a subsequent culture, in children with recurrent urinary tract infections. The medical records of all children with at least two episodes of urinary tract infection between 1999–2015 that occurred 2 weeks to 1 year apart were reviewed. Pathogen identity and antibiogram were compared between the two cultures for every patient. One hundred sixty-one cases of recurrent urinary tract infections were identified. Seventy-seven (48%) pairs of cultures grew the same pathogen. However, of these, 31 had an altered biogram. In 53% of the culture pairs, the pathogen in the second culture had a similar or better antibiotic susceptibility profile. We found no statistically significant correlation between the elapsed time between the two cultures and the probability of similar susceptibility profile between them. There was no correlation between antibiogram change and any of the demographic characteristics, including a history of renal transplantation and taking antibiotic prophylactic treatment.

Conclusions: Antibiotic susceptibility profile of the pathogen in a prior urinary tract infection did not predict antibiotic susceptibility profile in a subsequent urinary tract infection in our study.

What is Known:

• Children with urinary tract infections often have recurrent infections.

• Clinicians often use prior urine cultures to choose empirical antibiotic treatment in subsequent infections.

What is New:

• In only 50% of the cases, a subsequent urinary tract infection grows the same pathogen as the 1st urinary tract infection.

• Even in cultures with the same pathogen growth, antibiogram is often different.

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Abbreviations

ESBL:

Extended spectrum beta lactamases

IQR:

Interquartile range

SD:

Standard deviation

SPS:

Supra pubic aspiration

UTI:

Urinary tract infections

References

  1. Anacleto FE, Resontoc LP, Padilla GH (2009) Bedside diagnosis of outpatient childhood urinary tract infection using three-media dipslide culture test. Pediatr Nephrol 24:1539–1543. https://doi.org/10.1007/s00467-009-1217-7

    Article  PubMed  Google Scholar 

  2. Beetz R (2006) May we go on with antibacterial prophylaxis for urinary tract infections? Pediatr Nephrol 21:5–13

    Article  CAS  Google Scholar 

  3. Broeren M, Nowacki R, Halbertsma F, Arents N, Zegers S (2019) Urine flow cytometry is an adequate screening tool for urinary tract infections in children. Eur J Pediatr 178:363–368. https://doi.org/10.1007/s00431-018-3307-7

    Article  CAS  PubMed  Google Scholar 

  4. Clinical and Laboratory Standards Institute (CLSI) (2015) Performance standards for antimicrobial susceptibility testing: seventeenth informational supplement. CLSI document M100-S25. CLSI, Wayne

    Google Scholar 

  5. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R (2007) Recurrent urinary tract infections in children, risk factors and association with prophylactic antimicrobials. JAMA 298:179–186

    Article  CAS  Google Scholar 

  6. Dayan N, Dabbah H, Weissman I, Aga I, Even L, Glikman D (2013) Urinary tract infections caused by community-acquired extended-spectrum β-lactamase-producing and nonproducing bacteria: a comparative study. J Pediatr 163:1417–1421. https://doi.org/10.1016/j.jpeds.2013.06.078

    Article  PubMed  Google Scholar 

  7. Downing H, Thomas-Jones E, Gal M, Waldron CA, Sterne J, Hollingworth W, Hood K, Delaney B, Little P, Howe R, Wootton M, Macgowan A, Butler CC, Hay AD, DUTY study team (2012) The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness. BMC Infect Dis 12:158. https://doi.org/10.1186/1471-2334-12-158

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hewitt IK, Pennesi M, Morello W, Ronfani L, Montini G. Antibiotic prophylaxis for urinary tract infection-related renal scarring: a systematic review. Pediatrics. 2017;139(5). https://doi.org/10.1542/peds.2016-3145.

  9. Ikäheimo R, Siitonen A, Heiskanen T, Kärkkäinen U, Kuosmanen P, Lipponen P, Mäkelä PH (1996) Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis 22:91–99

    Article  Google Scholar 

  10. MacFadden DR, Ridgway JP, Robicsek A, Elligsen M, Daneman N (2014) Predictive utility of prior positive urine cultures. Clin Infect Dis 59:1265–1271. https://doi.org/10.1093/cid/ciu588

    Article  CAS  PubMed  Google Scholar 

  11. Marcus N, Ashkenazi S, Yaari A, Samra Z, Livni G (2005) Non-Escherichia coli versus Escherichia coli community-acquired urinary tract infections in children hospitalized in a tertiary center: relative frequency, risk factors, antimicrobial resistance and outcome. Pediatr Infect Dis J 24:581–585

    Article  Google Scholar 

  12. Quaak CH, Cové E, Driessen GJ, Tramper-Stranders GA (2018) Trends in paediatric inpatient antibiotic therapy in a secondary care setting. Eur J Pediatr 77:1271–1278. https://doi.org/10.1007/s00431-018-3185-z

    Article  Google Scholar 

  13. Robinson JO, Phillips M, Christiansen KJ, Pearson JC, Coombs GW, Murray RJ (2014) Knowing prior methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization status increases the empirical use of glycopeptides in MRSA bacteraemia and may decrease mortality. Clin Microbiol Infect 20:530–535. https://doi.org/10.1111/1469-0691.12388

    Article  CAS  PubMed  Google Scholar 

  14. Sakran W, Smolkin V, Odetalla A, Halevy R, Koren A (2015) Community-acquired urinary tract infection in hospitalized children: etiology and antimicrobial resistance. A comparison between first episode and recurrent infection. Clin Pediatr 54:479–483. https://doi.org/10.1177/0009922814555974

    Article  Google Scholar 

  15. Shaikh N, Mattoo TK, Keren R, Ivanova A, Cui G, Moxey-Mims M, Majd M, Ziessman HA, Hoberman A (2016) Early antibiotic treatment for pediatric febrile urinary tract infection and renal scarring. JAMA Pediatr 170:848–854. https://doi.org/10.1001/jamapediatrics.2016.1181

    Article  PubMed  Google Scholar 

  16. Smellie JM, Poulton A, Prescod NP (1994) Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ 308:193–196

    Article  Google Scholar 

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Authors and Affiliations

  1. The Hebrew University Hadassah Medical School, Jerusalem, Israel

    Reut Doyev & Orli Megged

  2. Pediatric Department, Shaare Zedek Medical Center, P.O.B. 3235, Jerusalem, Israel

    Efrat Ben-Shalom & Orli Megged

  3. Pediatric Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel

    Efrat Ben-Shalom

  4. Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel

    Orli Megged

Authors
  1. Reut Doyev
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  2. Efrat Ben-Shalom
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  3. Orli Megged
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Contributions

Author R.D. collected the data, wrote the manuscript.

Author E. BS. Performed the statistical analysis, helped planning the study and reviewed the manuscript.

Author O. M planned the study and critically reviewed the manuscript.

Corresponding author

Correspondence to Orli Megged.

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The authors declare that they have no conflict of interest. The study was approved by the local IRB committee.

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Doyev, R., Ben-Shalom, E. & Megged, O. The predictive utility of prior positive urine culture in children with recurrent urinary tract infections. Eur J Pediatr 179, 415–421 (2020). https://doi.org/10.1007/s00431-019-03522-5

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  • DOI: https://doi.org/10.1007/s00431-019-03522-5

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