Abstract
Gram-positive (GP) pathogens are less accounted for in pediatric urinary tract infection (UTI), and their clinical impact is underrecognized. This study aimed to identify predictors of GP uropathogens in pediatric UTI. In this 14-year retrospective cohort of pediatric patients with UTI, we classified first-time UTIs cases into those caused by GP or Gram-negative (GN) bacteria. We constructed a multivariable logistic regression model to predict GP UTI. We evaluated model performance through calibration and discrimination plots. We developed a nomogram to predict GP UTI that is clinically feasible. Of 3783 children with first-time UTI, 166 (4.4%) were infected by GP and 3617 (95.6%) by GN bacteria. Among children with GP UTI, the most common uropathogens were vancomycin-resistant Enterococcus faecalis (VRE) (27.1%), Staphylococcus saprophyticus (26.5%), and coagulase-negative Staphylococci (12.7%). Eight independent risk factors were associated with GP UTI: Age ≥ 24 months (odds ratio [OR]: 3.21), no prior antibiotic use (OR: 3.13), serum white blood cell (WBC) count < 14.4 × 103/μL (OR: 2.19), high sensitivity C-reactive protein (hsCRP) < 3.4 mg/dL (OR: 2.18), hemoglobin ≥ 11.3 g/dL (OR: 1.90), negative urine leukocyte esterase (OR: 3.19), negative urine nitrite (OR: 4.13), and urine WBC < 420/μL (OR: 2.37). The model exhibited good discrimination (C-statistic 0.879; 95% CI 0.845–0.913) and calibration performance. VR E. faecalis, the leading GP uropathogen causing pediatric UTI, requires early detection for infection control. Our model for predicting GP UTI can help clinicians detect GP uropathogens and administer antibiotic regimen early.
Highlights
Gram-positive (GP) pathogens are less accounted for in pediatric urinary tract infection (UTI), and their clinical impact is underrecognized
From 2003 through 2016, we identified 28,874 paired urinalysis (UA) and urine culture (UC) samples obtained from pediatric patients at China Medical University Hospital (CMUH), and 26,066 UA–UC pairs were obtained for the same visit from the same patient[13] (Fig. 1)
The proportion of pediatric UTI caused by GP bacteria remained stable from 2003 (6.0%) through 2016 (4.7%; Supplemental Fig. 1)
Summary
Gram-positive (GP) pathogens are less accounted for in pediatric urinary tract infection (UTI), and their clinical impact is underrecognized. This study aimed to identify predictors of GP uropathogens in pediatric UTI In this 14-year retrospective cohort of pediatric patients with UTI, we classified first-time UTIs cases into those caused by GP or Gram-negative (GN) bacteria. VR E. faecalis, the leading GP uropathogen causing pediatric UTI, requires early detection for infection control. Our model for predicting GP UTI can help clinicians detect GP uropathogens and administer antibiotic regimen early. Pediatric patients with UTIs caused by GP bacteria, Enterococcus spp. and S. aureus, are likely to have concomitant anatomical abnormalities, such as hydronephrosis or vesicoureteral reflux (VUR), and do not respond to empirical antibiotic therapy for GN bacterial infection[7,8,9,10]. To fill this knowledge gap, we conducted a retrospective study to compare the clinical features and outcomes of GN and GP UTIs and developed a prediction model for GP UTIs in patients younger than 18 years
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