Abstract
This study aimed to investigate the predictive factors of concomitant bacteremia occurring in febrile infants who initially presented with pyuria and fever, and were subsequently diagnosed with culture-proven urinary tract infection (UTI). We conducted a retrospective cohort study for January 2010–October 2018 that included infants younger than six months with febrile UTI at a tertiary hospital. The study included 463 patients, of whom 34 had a concomitant bacteremic UTI. Compared to those in the non-bacteremic urinary tract infection (UTI) group, the bacteremic UTI group had a lower mean age; higher levels of C-reactive protein (CRP), delta neutrophil index (DNI, reflects the fraction of immature granulocytes) and blood urea nitrogen (BUN); lower levels of hemoglobin (Hb) and albumin; and a lower platelet count. Vesicoureteral reflux (VUR) was detected nearly twice as often in patients with bacteremic UTI compared to those with non-bacteremic UTI (59.3% vs. 30.6%; P = 0.003). Univariate logistic analyses showed that age ≤90 days; higher DNI, CRP, and creatinine levels; lower Hb and albumin levels; and the presence of VUR were predictors for bacteremic UTI. On multivariate logistic regression analysis, age ≤90 days, higher DNI and CRP levels, and the presence of VUR were independent predictors of bacteremic UTI. The area under the receiver operating characteristic curve of the multivariate model was 0.859 (95% CI, 0.779–0.939; P < 0.001). Age ≤90 days, higher DNI and CRP values may help predict bacteremia of febrile infants younger than 6 months with UTI. Vesicoureteral reflux imaging is also recommended in infants with bacteremic UTI to evaluate VUR.
Highlights
Preceding pediatric studies have reported that the prevalence of concomitant bacteremic Urinary tract infection (UTI) was mostly limited to infants younger than six months[4,6]
The bacteremic UTI group exhibited shorter fever duration before admission (P = 0.032); higher CRP level (P < 0.001), delta neutrophil index (DNI), which reflects the level of immature granulocytes (P = 0.006), and blood urea nitrogen (BUN) (P < 0.001); and lower levels of hemoglobin (Hb)(P = 0.021), albumin (P = 0.002), and platelet counts (P = 0.043); No significant differences were found in sex, total duration of fever, WBC, absolute neutrophil count, erythrocyte sedimentation rate, sodium, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, or presence of a positive urine nitrite test (Table 1)
This study showed that age ≤90 days, higher levels of CRP and DNI, and the presence of vesicoureteral reflux (VUR) were significantly associated with concomitant bacteremic UTI in multivariate analysis
Summary
Preceding pediatric studies have reported that the prevalence of concomitant bacteremic UTI was mostly limited to infants younger than six months[4,6]. The prevalence of UTI in infants aged 3–6 months was similar to that in those younger than three months in a previous meta-analysis[17]; studies that assessed the risk factors in predicting bacteremic UTI were mainly focused on infants younger than three months[5,7,10,11]. This study aimed to investigate the initial risk factors for bacteremia in infants aged younger than six months with febrile UTI at presentation, confirming previously established parameters and identifying other new laboratory findings
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