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Community-acquired enterococcal urinary tract infections in hospitalized children

Nir Marcus1, Shai Ashkenazi, Zmira Samra

  • 1Department of Pediatrics A, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel.

Pediatric Nephrology (Berlin, Germany)
|August 9, 2011
PubMed

Insights

Community-acquired enterococcal urinary tract infections (UTIs) in children are linked to urinary abnormalities and often receive inappropriate initial antibiotic treatment. Early detection and renal imaging are crucial for effective management.

Area of Science:

  • Pediatric Infectious Diseases
  • Urology
  • Clinical Microbiology

Background:

  • Community-acquired urinary tract infections (UTIs) are common in children.
  • Enterococcal UTIs represent a significant, though less common, cause of pediatric UTIs.
  • Understanding risk factors and treatment outcomes for enterococcal UTIs is essential for optimizing patient care.

Purpose of the Study:

  • To characterize community-acquired (CA) enterococcal UTIs in a pediatric tertiary care setting.
  • To identify risk factors associated with enterococcal UTIs.
  • To evaluate the association with renal abnormalities, antibiotic susceptibility, and empiric treatment appropriateness compared to Gram-negative UTIs.

Main Methods:

  • Prospective 5-year clinical and laboratory study.
  • Analysis of culture-proven CA UTIs in 355 pediatric patients.
  • Comparison of enterococcal UTI cases (n=22) with Gram-negative UTI cases.

Main Results:

  • Enterococcal UTIs accounted for 6.2% of CA UTIs.
  • Enterococcal UTIs were associated with male predominance, higher rates of underlying urinary abnormalities (70% vs. 43.7%), and vesicoureteral reflux (53%).
  • Inappropriate empiric antibiotic therapy was significantly higher for enterococcal UTIs (22% vs. 5.6%).

Conclusions:

  • Early detection of CA enterococcal UTIs is important due to their association with urinary abnormalities.
  • A high rate of inappropriate empiric antibiotic therapy necessitates prompt diagnosis.
  • Renal imaging is recommended for children with enterococcal UTIs; Gram stain can aid early diagnosis.

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