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Bacteremia and meningitis among infants with urinary tract infections
1Department of Pediatrics, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Abstract:
A retrospective analysis of 354 patients < or = 2 years of age with urinary tract infections (UTIs) was performed to characterize patients with bacteremia or meningitis and to identify any objective predictors of these complications. Thirty-three patients with bacteremia were identified. Blood culture isolates included Escherichia coli (25), Staphylococcus aureus (4), enterococcus (1), group B Streptococcus (2), and Enterobacter (1). Besides one patient with group B Streptococcus bacteremia at 1.5 months of age, all bacteremias after one month of age were with E. coli. Bacteremia was limited to those < 6 months old and inversely related to age (R = 0.24, P = 0.0008). Grouped by age, the incidence of bacteremia was 21% for 0 < or = 1 month, 13% for 1.1-2.0 months, 4% for 2.1-3.0 months, and 8% for 3.1-6.0 months. Mean white blood cell count, initial temperature, initial serum bicarbonate, and erythrocyte sedimentation rate were not statistically significant between bacteremic (B) and nonbacteremic (NB) patients. Statistically significant differences were noted for percentage of bands (6.2% [NB] vs. 12.3% [B] P < 0.001), total band count (1048 [NB] vs. 2252 [B] P < 0.001), and band-neutrophil ratio (0.16 [NB] vs. 0.36 [B] P = 0.01); however, no practical value for any of these measures would reliably discriminate between bacteremic and nonbacteremic patients. Four patients, all neonates, had meningitis; too few patients with meningitis were identified for analysis. In summary, bacteremia with UTIs was observed to be inversely related to age and limited to patients less than six months of age. No objective parameters were identified to distinguish patients with bacteremia at the time of presentation.
Insights
Urinary tract infections (UTIs) in young children can lead to bacteremia, a bloodstream infection, primarily in infants under six months. No reliable indicators were found to predict bacteremia in these patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Microbiology
Background:
- Urinary tract infections (UTIs) are common in infants and young children.
- Complications such as bacteremia and meningitis can arise from UTIs.
- Early identification of risk factors for these complications is crucial.
Purpose of the Study:
- To characterize patients with UTIs who develop bacteremia or meningitis.
- To identify objective predictors of bacteremia and meningitis in young children with UTIs.
Main Methods:
- Retrospective analysis of 354 patients aged 2 years or younger with UTIs.
- Review of patient demographics, clinical presentation, and laboratory results.
- Statistical analysis to identify correlations and predictors of bacteremia.
Main Results:
- Thirty-three patients (9.3%) had bacteremia, predominantly caused by Escherichia coli.
- Bacteremia incidence was inversely related to age, occurring only in patients under six months.
- No significant differences in white blood cell count, temperature, or bicarbonate levels were found between bacteremic and non-bacteremic groups.
- While band neutrophils and band-neutrophil ratios differed significantly, they lacked practical discriminatory value.
- Four neonates (1.1%) had meningitis; insufficient numbers for analysis.
Conclusions:
- Bacteremia associated with UTIs in young children is limited to those under six months of age and inversely correlates with age.
- No reliable objective clinical or laboratory parameters were identified to predict bacteremia at presentation in this cohort.
- Further research may be needed to identify predictive markers for UTI complications in infants.