Comparison of Febrile Infants With Enterococcal and Gram-negative Urinary Tract Infections

Abstract

Febrile infants with enterococcal UTIs had a low likelihood of adverse events or severe clinical course, similar to those with Gram-negative UTIs. Infants with enterococcal UTIs frequently had underlying hydronephrosis and/or vesicoureteral reflux. The preliminary diagnosis of enterococcal UTIs may be inaccurate if based on UA.

Efficacy of Empiric Treatment of Urinary Tract Infections in Neonates and Young Infants

“…15 Previous studies have demonstrated the significant differences between Enterococcus and gram-negative pathogens in febrile infants, including differences in gestational age, resistance patterns, pyuria, and urinary tract abnormalities. 6,14,16,17 Our findings of variation in LOS compared with gram-negative pathogens substantiates previous findings differences in clinical course of Enterococcus UTIs. 16…”

“…6,14,16,17 Our findings of variation in LOS compared with gram-negative pathogens substantiates previous findings differences in clinical course of Enterococcus UTIs. 16…”

Urinary Neutrophil Gelatinase–Associated Lipocalin for the Diagnosis of Urinary Tract Infections

“…Additionally, though most UTIs caused by E. coli demonstrate an inflammatory response (and positive UA), several studies in children have found that certain non-E. coli uropathogens and gram-positive organisms are less likely to be associated with pyuria. 34–36 uNGAL may offer an advantage in this respect as NGAL levels in UTIs appear to mainly reflect the kidneys’ response to inflammation, independent of leukocyte activation. 11,25…”

What Urinary Colony Count Indicates a Urinary Tract Infection in Children?

“…Lubell et al in a multicenter emergency department study of 1870 infants 29–60 days of age diagnosed with UTI based on symptoms and either pyuria or a positive urine gram stain found that 6% had colony counts of 10,000–49,000 CFU/mL, 3% reported as 10,000 to 100,000 CFU/ml, and 20% reported as 50,000 to 100,000 CFU/ml. 13 Thus potentially 9% of these infants might not have been diagnosed with a UTI unless the colony count cut-off is decreased to 10,000 CFU/ml. Similarly Schroeder et al report that 5% of their infants less than 3 months of age with a bacteremic UTI had colony counts between 10,000 and 49,000 CFU/ml.…”

“…Similarly, Lubell found that the sensitivity of pyuria was 75.9% for infants with an enterocoocal UTI compared with 93.9% for those with an E. coli UTI. 13 Perhaps when organisms other than E coli are found in a urine without pyuria, physicians should have a higher index of suspicion for a UTI as these organisms may generate less of an inflammatory response.…”