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Diagnosis and management of bacteremic urinary tract infection in infants
Heidi K Roman1, Pearl W Chang2, Alan R Schroeder3
1Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California; and heidi.roman@utsouthwestern.edu.
Insights
Bacteremia occurs in 4.1% of infant urinary tract infections (UTIs). While treatment varied, infants with bacteremic UTIs experienced excellent outcomes with no recurrent infections within 30 days.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Urinary tract infections (UTIs) are common in infants.
- Bacteremia, the presence of bacteria in the bloodstream, can complicate UTIs.
- Understanding the prevalence and outcomes of bacteremic UTIs in infants is crucial for clinical management.
Purpose of the Study:
- To determine the prevalence of bacteremia in infants under one year old with UTIs.
- To compare the clinical characteristics of infants with and without bacteremia.
- To describe treatment courses and 30-day outcomes for infants with bacteremic versus non-bacteremic UTIs.
Main Methods:
- Retrospective cross-sectional study design.
- Analysis of 1379 infant UTIs, with blood cultures obtained in 52%.
- Double cohort design (age and gender matched) for comparing bacteremic and non-bacteremic groups.
Main Results:
- Overall prevalence of bacteremia in infant UTIs was 4.1%.
- No significant differences in clinical presentation between bacteremic and non-bacteremic groups, except minor urinalysis and band count variations.
- Bacteremic infants received longer parenteral treatment (mean 6.7 days vs 2.4 days).
Conclusions:
- Treatment duration for bacteremic UTIs in infants was variable but associated with excellent outcomes.
- No bacteremic infant experienced recurrent UTI or bacteremia with the same organism within 30 days post-discharge.
Objectives:
To report the prevalence of bacteremia by age in a sample of infants<1 year of age with urinary tract infections (UTIs), to compare characteristics of infants with UTIs with and without bacteremia, and to describe treatment courses and 30-day outcomes in infants with UTIs with and without bacteremia.
Methods:
We used a retrospective cross-sectional design to determine the prevalence of bacteremia in infants with UTIs at our institution. A double cohort design matching for age and gender was used to compare clinical characteristics and outcomes between infants with bacteremic versus nonbacteremic UTIs.
Results:
We identified 1379 UTIs, with blood cultures obtained in 52% of cases. The prevalence of bacteremia was 4.1% (95% confidence interval 3.1%-5.3%) for all UTIs and 8% (95% confidence interval 6.1%-10.2%) for UTIs in which blood culture was obtained. Fifty-five infants with bacteremic UTIs were compared with 110 infants with nonbacteremic UTIs. Except for minor differences in the urinalysis and serum band count, there were no significant differences in clinical presentation between the 2 groups. Bacteremic infants received longer parenteral treatment courses than nonbacteremic infants (mean 6.7 vs 2.4 days, P<.001). Treatment courses in the bacteremic group were variable and predicted by age but not severity of illness. No bacteremic infant had recurrent UTI or bacteremia with the same organism within 30 days of discharge.
Conclusions:
Treatment was variable but outcomes were excellent in infants with bacteremic UTIs.
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