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Fever, bacteriuria and concomitant disease in children with urinary tract infection
S Mårild1, M Hellström, U Jodal
1Department of Pediatrics, Gothenburg University, Sweden.
Insights
This study on pediatric febrile urinary tract infections found distinct patient groups. Children with uncomplicated infections often had specific E. coli, while those with complications showed different bacterial types and inflammation markers.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Nephrology
Background:
- Febrile urinary tract infection (UTI) is common in children.
- Understanding UTI heterogeneity is crucial for appropriate management.
- First-time febrile UTI in young children requires careful evaluation.
Purpose of the Study:
- To investigate the heterogeneity of first-time febrile urinary tract infections in children aged 0.2 to 6 years.
- To stratify patients based on fever, bacteriuria, and concomitant disease.
- To identify differences in causative pathogens and inflammatory markers between patient groups.
Main Methods:
- Enrolled 124 children aged 0.2 to 6 years with first-time febrile UTI.
- Stratified patients into groups based on fever severity, bacteriuria confirmation, and presence of concomitant disease.
- Analyzed bacterial types (attaching vs. nonattaching E. coli), receptor specificity, C-reactive protein levels, and microsedimentation rates.
Main Results:
- Identified a major group (88 patients) with high fever, confirmed bacteriuria, no concomitant disease, and infection with attaching E. coli.
- A smaller group (11 patients) with bacteriuria and concomitant disease showed nonattaching bacteria, lower C-reactive protein, and lower sedimentation rates.
- Five children in the second group exhibited reduced renal concentrating capacity.
Conclusions:
- Pediatric febrile UTI presents with significant heterogeneity.
- Distinct bacterial profiles and inflammatory responses are associated with different clinical presentations.
- Renal involvement cannot be excluded in any subgroup, highlighting the need for comprehensive assessment.
Abstract:
A total of 124 children aged 0.2 to 6 years were enrolled in a study of first time febrile urinary tract infection. The patient population was stratified in groups according to the stringency of criteria for fever and bacteriuria and the presence of concomitant disease. The major group of 88 patients consisted of children with fever greater than or equal to 38.5 degrees C measured at the hospital within 24 hours of diagnosis, bacteriuria verified by suprapubic bladder aspiration or repeated cultures of voided urine, but without concomitant disease. These children were mainly infected with attaching Escherichia coli specific for galactose alpha (1----4) beta galactose containing receptors and had laboratory evidence of inflammation. Another group of 11 children were distinguished with strictly defined bacteriuria and concomitant disease. These children were infected with nonattaching bacteria and had lower concentrations of C-reactive protein in serum and lower microsedimentation rates than the major group. Five of these children had a reduction in renal concentrating capacity. The study emphasizes the heterogeneity among patients with fever and bacteriuria but does not rule out the possibility of renal involvement in any subgroup.