Predictive Factors of Low Risk for Bacteremia in Infants With Urinary Tract Infection

Velasco, Roberto; Trujillo, Juan; Fernández-Arribas, José; Serrano-Carro, Beatriz; Campo-Fernández, Nathalie; Puente-Montes, Sara

doi:10.1097/inf.0b013e31824bf145

Cited by 15 publications

(27 citation statements)

References 7 publications

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“…In the same study, the presence of bacteremia was associated with a higher frequency of complications [18]. Similar data has also been reported in a smaller cohort of 140 children [19].…”

Section: Clinical Manifestationssupporting

confidence: 66%

Acute pyelonephritis in children

et al. 2015

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Acute pyelonephritis is one of the most serious bacterial illnesses during childhood. Escherichia coli is responsible in most cases, however other organisms including Klebsiella, Enterococcus, Enterobacter, Proteus, and Pseudomonas species are being more frequently isolated. In infants, who are at major risk of complications such as sepsis and meningitis, symptoms are ambiguous and fever is not always useful in identifying those at high risk. A diagnosis of acute pyelonephritis is initially made on the basis of urinalysis; dipstick tests for nitrites and/or leukocyte esterase are the most accurate indicators of infection. Collecting a viable urine sample for urine culture using clean voided methods is feasible, even in young children. No gold standard antibiotic treatment exists. In children appearing well, oral therapy and outpatient care is possible. New guidelines suggest less aggressive imaging strategies after a first infection, reducing radiation exposure and costs. The efficacy of antibiotic prophylaxis in preventing recurrence is still a matter of debate and the risk of antibiotic resistance is a warning against its widespread use. Well-performed randomized controlled trials are required in order to better define both the imaging strategies and medical options aimed at preserving long-term renal function.

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“…In the same study, the presence of bacteremia was associated with a higher frequency of complications [18]. Similar data has also been reported in a smaller cohort of 140 children [19].…”

Section: Clinical Manifestationssupporting

confidence: 66%

Acute pyelonephritis in children

et al. 2015

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“…Este hallazgo es similar al descrito en la literatura, donde la frecuencia de bacteriemia oscila entre el 2 y el 21% según la edad de los pacientes y el diseño del estudio 1,8,9,11,12,20 . La frecuencia de bacteriemia en la población estudiada es significativamente superior en aquellos pacientes con un TEP alterado, lo cual ratifica la utilidad de dicha herramienta clínica para discriminar los pacientes de bajo y alto riesgo de bacteriemia 11,12 . La frecuencia de bacteriemia encontrada en el grupo de pacientes de 61 a 90 días apoyaría su manejo ambulatorio siempre y cuando presenten un TEP normal y una buena tolerancia oral, tal y como recomiendan diversas autoridades, como la Guía de Práctica Clínica de la Academia Americana de Pediatría 21 y la Sociedad Italiana de Nefrología Pediátrica 22 .…”

Section: Discussionunclassified

“…En relación con la presencia de otras complicaciones, 2 neonatos (0,4%) desarrollan un absceso renal, y otros 2 pacientes presentan complicaciones no relacionadas con la ITU, todos ellos con buena evolución posterior. La baja presencia de complicaciones en los pacientes mayores de 28 días constata la necesidad de identificar aquellos con bajo riesgo de presentarlas para un manejo menos intensivo 11,12 .…”

Section: Discussionunclassified

“…Sin embargo, diversos estudios han demostrado una baja frecuencia de dichas complicaciones, especialmente si el tratamiento antibiótico se instaura de forma precoz [6][7][8][9][10] . A raíz de los estudios mencionados, en los últimos años diversos autores han tratado de identificar factores de riesgo para su presentación en los lactantes mayores de 28 días, planteando la posibilidad de un manejo menos intensivo para aquellos lactantes considerados de bajo riesgo [11][12][13] . Para ello, además de determinar la frecuencia de complicaciones, es esencial conocer los microorganismos responsables y su sensibilidad antibiótica.…”

Section: Introductionunclassified

“…Para ello, además de determinar la frecuencia de complicaciones, es esencial conocer los microorganismos responsables y su sensibilidad antibiótica. En España son escasos los estudios al respecto en este grupo de edad 12,14 .…”

Section: Introductionunclassified

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Etiología y curso clínico de la infección del tracto urinario en los lactantes menores de 3 meses

Hernández-Bou

Maza

Gamarra

et al. 2015

Enfermedades Infecciosas y Microbiología Clínica

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Validation of a predictive model for identifying febrile young infants with altered urinalysis at low risk of invasive bacterial infection

Velasco

Gómez

Hernández-Bou

et al. 2016

Eur J Clin Microbiol Infect Dis

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In 2015, a predictive model for invasive bacterial infection (IBI) in febrile young infants with altered urine dipstick was published. The aim of this study was to externally validate a previously published set of low risk criteria for invasive bacterial infection in febrile young infants with altered urine dipstick. Retrospective multicenter study including nine Spanish hospitals. Febrile infants ≤90 days old with altered urinalysis (presence of leukocyturia and/or nitrituria) were included. According to our predictive model, an infant is classified as low-risk for IBI when meeting all the following: appearing well at arrival to the emergency department, being >21 days old, having a procalcitonin value <0.5 ng/mL and a C-reactive protein value <20 mg/L. IBI was considered as secondary to urinary tract infection if the same pathogen was isolated in the urine culture and in the blood or cerebrospinal fluid culture. A total of 391 patients with altered urine dipstick were included. Thirty (7.7 %) of them developed an IBI, with 26 (86.7 %) of them secondary to UTI. Prevalence of IBI was 2/104 (1.9 %; CI 95% 0.5-6.7) among low-risk patients vs 28/287 (9.7 %; CI 95% 6.8-13.7) among high-risk patients (p < 0.05). Sensitivity of the model was 93.3 % (CI 95% 78.7-98.2) and negative predictive value was 98.1 % (93.3-99.4). Although our predictive model was shown to be less accurate in the validation cohort, it still showed a good discriminatory ability to detect IBI. Larger prospective external validation studies, taking into account fever duration as well as the role of ED observation, should be undertaken before its implementation into clinical practice.

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Predictive Factors of Low Risk for Bacteremia in Infants With Urinary Tract Infection

Abstract: We studied 140 febrile infants between 30 and 90 days of age who had a positive urine culture to analyze the risk for complications. Patients with a healthy appearance and C-reactive protein blood value less than 40 mg/L had a very small probability of complications.

Cited by 15 publications

References 7 publications

Acute pyelonephritis in children

Acute pyelonephritis in children

Etiología y curso clínico de la infección del tracto urinario en los lactantes menores de 3 meses

Validation of a predictive model for identifying febrile young infants with altered urinalysis at low risk of invasive bacterial infection

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