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Urinary tract infection in infants: the significance of low bacterial count

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

The study was approved by the Regional Ethical Review Board in Gothenburg (278-08).

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Authors and Affiliations

  1. Department of Pediatrics, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden

    Svante Swerkersson, Ulf Jodal & Sverker Hansson

  2. Department of Clinical Bacteriology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Christina Åhrén

  3. STRAMA, The Swedish Strategic Programme against Antibiotic Resistance, Region of Västra Götaland, Göteborg, Sweden

    Christina Åhrén

  4. Pediatric Clinical Physiology, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden

    Rune Sixt

  5. Pediatric Radiology, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden

    Eira Stokland

  6. Pediatric Uronephrologic Center, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, 416 85, Göteborg, Sweden

    Svante Swerkersson

Authors
  1. Svante Swerkersson
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  2. Ulf Jodal
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  3. Christina Åhrén
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  4. Rune Sixt
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  5. Eira Stokland
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  6. Sverker Hansson
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Correspondence to Svante Swerkersson.

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Swerkersson, S., Jodal, U., Åhrén, C. et al. Urinary tract infection in infants: the significance of low bacterial count. Pediatr Nephrol 31, 239–245 (2016). https://doi.org/10.1007/s00467-015-3199-y

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  • DOI: https://doi.org/10.1007/s00467-015-3199-y

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