MP69-16 CHARACTERISTICS AND MORBIDITY OF BACTEREMIA OF UROLOGIC ORIGIN IN THE PEDIATRIC PATIENT

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Reflux1 Apr 2018MP69-16 CHARACTERISTICS AND MORBIDITY OF BACTEREMIA OF UROLOGIC ORIGIN IN THE PEDIATRIC PATIENT Jesse Jacobs, Kevin Ginsburg, Kahlil Saad, and George Steinhardt Jesse JacobsJesse Jacobs More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , Kahlil SaadKahlil Saad More articles by this author , and George SteinhardtGeorge Steinhardt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2240AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bacteremia of urologic origin (BUO) is a common cause of sepsis in the adult population causing significant morbidity and mortality. We sought to review patient characteristics and morbidity of pediatric patients presenting with BUO. METHODS We retrospectively reviewed cases of pediatric patients with BUO at the Helen DeVos Children′s Hospital from 2010 to 2015. Study sample was obtained using combinations of the ICD-9 diagnostic code 599.0 (urinary tract infection, UTI), with 790.7 (bacteremia), 995.92 (severe sepsis), 995.91 (sepsis), and 591.10 (acute pyelonephritis). The electronic medical recorded was reviewed for relevant laboratory and clinic parameters. BUO was present if blood and urine cultures grew the same organism. If discordance between the blood and urine cultures existed, or the blood culture was negative, the patient was considered to have clinical pyelonephritis (CP). Neonatal patients were excluded. RESULTS We identified 121 pediatric patients with diagnosis codes consistent with BUO. Upon review of the chart, 87 patients met criteria for CP or BUO. Most patients were female (74.7%) with a median age of 3.0 years (IQR 0.25-10.0). Forty-four patients (50.6%) were classified as having BUO. Patients with underlying genitourinary (GU) structural abnormalities had similar proportions with BUO compared to children without GU abnormalities (53.8% vs 47.9%, p=0.668). E. coli was the causative agent in the majority of cases of CP (76.7%) and BUO (70.5%) p=0.628. There was a significant difference in mean length of intravenous antibiotic use in patients with BUO compared to CP (7.7 vs 5.1 days, p=0.023) and in the mean number of antibiotics used to treat the infection (1.9 vs 1.4, p=0.003). In the 44 children with BUO, children with GU structural abnormalities tended to be younger (2.6 vs 5.8 years), although this difference was not statistically significant (p=0.07). There was no difference in age, gender, length of stay (LOS), antibiotic usage, or rates of BUO compared to CP in patients diagnosed with a GU structural abnormality prior to admission, compared to those diagnosed during or after admission. CONCLUSIONS BUO in the pediatric patient is relatively rare, with only 44 cases across our 5-year study period. Underlying structural GU abnormalities did not significantly increase the risk for BUO compared to clinical pyelonephritis. Although LOS and other morbidity were similar, patients with BUO tended to be younger and require more IV antibiotic therapy. Further studies into the impact of GU structural abnormalities on the development of BUO is warranted. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e932 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jesse Jacobs More articles by this author Kevin Ginsburg More articles by this author Kahlil Saad More articles by this author George Steinhardt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...