Abstract

Research Article| April 01 2011 Febrile UTI in Infants 0–3 Months: Importance of Normal Renal US AAP Grand Rounds (2011) 25 (4): 39. https://doi.org/10.1542/gr.25-4-39 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Febrile UTI in Infants 0–3 Months: Importance of Normal Renal US. AAP Grand Rounds April 2011; 25 (4): 39. https://doi.org/10.1542/gr.25-4-39 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: fever, kidney, urinary tract infections Source: Ismaili K, Lolin K, Damry N, et al. Febrile urinary tract infections in 0- to 3-month-old infants: a prospective follow-up study. J Pediatr. 2011; 158(1): 91-94; doi: https://doi.org/10.1016/j.jpeds.2010.06.053Google Scholar Belgian investigators reviewed data collected prospectively on infants 0 to 3 months of age with a first febrile urinary tract infection (UTI) in order to characterize pathogens, antimicrobial resistance, renal abnormalities, gender predilection, and recurrences. Urine was collected using suprapubic aspiration or bladder catheterization. UTI was defined as growth of at least 100,000 colony-forming units/ml or any growth from urine collected by aspiration. Patients with multiple pathogens or nosocomial UTI were excluded. All infants were treated according to a protocol that included initial parenteral antibiotics and hospitalization. All infants underwent renal ultrasound (US) during hospitalization and a voiding cystourethrogram (VCUG) at least one month after the UTI. All patients were followed for at least one year. Of 209 children treated for a first episode of proved febrile UTI, 43 (21%) were infants 0 to 3 months of age. All infants had antenatal US of which 6 (14%) were known to be abnormal. Of the 43 infants, 32 (74%) were male. All boys were uncircumcised. Escherichia coli comprised 88% of the pathogens, Klebsiella pneumoniae 7%, and Enterobacter species and Staphylococcus aureus occurred once each. E coli resistance to ampicillin and trimethoprim-sulfamethoxazole was 71% and 47% respectively. Bacteremia accompanied the UTI in three infants (7%). Sixty-seven percent of the US results were normal. Nine infants (21%; 6 boys) had vesicoureteral reflux (VUR); six infants had low grade VUR (I-III) and all of these resolved spontaneously within two years. US was abnormal in three of the six infants with low grade VUR. All three infants with high grade VUR (IV, V) had US demonstrating hydronephrosis, signs of dysplasia, or both. Six infants (four girls) had recurrent UTI during follow-up. Three of those patients had urinary tract abnormalities. The authors conclude that 21% of children with a first febrile UTI are 0 to 3 months of age; there is a male preponderance in this age group; E coli is the most common pathogen and shows high rates of resistance to ampicillin and trimethoprim-sulfamethoxazole; and when US is normal in this population the incidence of high grade VUR is extremely low. Dr Garber has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Controversy exists over the current management of UTI in infants and children. AAP Grand Rounds has addressed the issues of imaging and antibiotic prophylaxis at least 13 times in the past decade. Guidelines vary from country to country, and there is considerable practice variation within the United States.1 The 1999 AAP practice parameter2 recommends renal US and VCUG on every patient 2 months to 2 years of age with a first febrile UTI, and antibiotic prophylaxis for those with an abnormal urinary tract.... You do not currently have access to this content.

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