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Bacteremic urinary tract infection in children
O Honkinen1, T Jahnukainen, J Mertsola
1Department of Pediatrics, University of Turku, Finland.
Insights
Clinical symptoms alone cannot reliably differentiate bacteremic urinary tract infections (UTIs) from non-bacteremic UTIs in children. However, bacteremic UTIs are associated with a higher incidence of urinary tract abnormalities, particularly in cases not caused by E. coli.
Area of Science:
- Pediatrics
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTIs) are common in children.
- Bacteremic UTIs, where bacteria are present in the bloodstream, require careful assessment.
- Distinguishing bacteremic from non-bacteremic UTIs based on clinical presentation is crucial for appropriate management.
Purpose of the Study:
- To evaluate the clinical characteristics of children diagnosed with bacteremic urinary tract infections (UTIs).
- To compare the clinical findings, laboratory results, and imaging data of children with bacteremic UTI versus those with non-bacteremic UTI.
Main Methods:
- A retrospective analysis of clinical data from Finnish children with bacteremic UTI (n=134) between 1985 and 1994.
- Comparison of symptoms, laboratory findings (serum C-reactive protein), and imaging results with age- and sex-matched controls with blood culture-negative UTI.
- Assessment of urinary tract abnormalities, including obstruction and vesicoureteral reflux (VUR).
Main Results:
- No significant differences in most clinical symptoms were observed between bacteremic and non-bacteremic UTI groups.
- Bacteremic children showed more frequent feeding problems and, if older than 12 months, abdominal pain and vomiting.
- Higher serum C-reactive protein levels and longer fever duration post-treatment were noted in bacteremic patients.
- Urinary tract abnormalities, specifically obstruction and high-grade VUR, were significantly more prevalent in bacteremic UTI cases, especially those not caused by E. coli.
Conclusions:
- Clinical symptoms are not reliable indicators for differentiating bacteremic from non-bacteremic UTIs in children.
- The outcomes of bacteremic and non-bacteremic UTIs were comparable.
- Bacteremic UTIs, particularly those caused by non-E. coli pathogens, are more frequently associated with underlying anatomical or functional urinary tract abnormalities.
Objective:
To assess the clinical characteristics of bacteremic urinary tract infection (UTI) in children.
Design:
Clinical data of Finnish children with bacteremic UTI (n = 134) from 1985 to 1994 were analyzed. Their symptoms, laboratory and imaging findings were compared with those of age- and sex-matched patients hospitalized for blood culture negative UTI.
Results:
Generally, no major differences were seen in clinical findings between bacteremic and nonbacteremic patients. Bacteremic children had more frequent feeding problems (P = 0.02), and children > or =12 months of age tended more often to have abdominal pain and vomiting than did nonbacteremic patients. Fever was the major initial symptom in both study groups, but no significant difference occurred in the mean highest temperature or in the mean of duration of fever before admission to the hospital. The mean concentration of serum C-reactive protein on admission was significantly higher in bacteremic patients (116 vs. 76 mg/l; P < 0.01). After onset of antimicrobial treatment fever lasted significantly longer in bacteremic patients than in control patients (means, 2.3 vs. 1.1 days; P < 0.01). Anatomic or functional abnormalities in the urinary tract were detected in 51% vs. 46%, respectively. Obstruction of the urinary tract (9% vs. 1%, P < 0.01) and Grade 3 to 5 vesicoureteral reflux (30% vs. 16%, P = 0.02) were significantly more frequent in bacteremic patients with UTI. Obstruction or vesicoureteral reflux was found in 46% of children with bacteremic UTI caused by Escherichia coli vs. 89% of children with non-E. coli infection (P < 0.01).
Conclusions:
Clinical symptoms do not significantly distinguish bacteremic from nonbacteremic children with UTI. Outcome of bacteremic UTI was comparable with that of nonbacteremic UTI. Bacteremic children, especially those with non-E. coli UTI, more often had anatomical or functional abnormalities in the urinary tract.