Bacteremia In Infants Research Articles

Risk factors for bacteremia in infants with urinary tract infection

BackgroundSome infants with urinary tract infection (UTI) may exhibit concurrent bacteremia, potentially leading to septic shock or bacterial meningitis. Identifying risk factors for bacteremia in infants with UTI is crucial for prompt intervention to prevent subsequent adverse outcomes. MethodsBetween 2015 and 2021, a total of 632 infants with UTI aged ≤12 months were enrolled at Kaohsiung Veterans General Hospital (KSVGH), among whom 20 had concurrent bacteremia. We analyzed their differences in outcomes and demographic, clinical, and laboratory characteristics. Independent risk factors for bacteremic UTI were identified using binary logistic regression analysis. ResultsA positive underlying disease (including congenital anomalies of kidney and urinary tract [CAKUT] and prematurity), C-reactive protein (CRP) > 8 mg/dL, lower body weight, and positive urinary nitrite were independent risk factors for infants with UTI and bacteremia. ConclusionsPhysicians should be mindful of the potential for bacteremia to develop in infants with UTI, particularly those with concurrent positive underlying diseases or CRP >8 mg/dL.

Risk of Urinary Tract Infection and Bacteremia in Infants Infected With COVID-19.

Our objective was to evaluate the risk of urinary tract infection (UTI) and bacteremia in infants 1 year or less of age infected with COVID-19. This was a retrospective study from TriNetX database in the United States. This study was from March 11, 2020, to May 11, 2023, during the COVID-19 pandemic. Patients were included if they were infants, 1 year or less, had a fever, and had a COVID-19 polymerase chain reaction test 1 week before or after presentation to the emergency department (ED) or hospital. We compared outcomes of bacteremia and a UTI in those with COVID-19 and those without COVID-19. Propensity matching was done to account for the confounders of age, gender, race, immune disorders, genitourinary abnormalities, preterm birth, and circumcision. Infants who were positive for COVID-19 were at a reduced risk of UTI and bacteremia. There was a significant decreased risk of having a UTI if one had COVID-19 (1.0%) versus those without COVID-19 (2.3%) (risk ratio = 0.37, 95% confidence interval = 0.37-0.50, P < 0.001). For bacteremia, there was also a decreased risk if the infant had COVID-19 (0.4%), versus those without COVID-19 (0.5%) (risk ratio = 0.74, 95% confidence interval = 0.56-0.97, P = 0.03). Infants with fever found to have COVID-19 had lower risks of UTI and bacteremia.

Risk factors, antimicrobial susceptibility, and outcome of methicillin-resistant Staphylococcus aureus bacteremia in critically ill children with sepsis in a tertiary hospital in Egypt

Background Staphylococcus aureus bacteremia (SAB) and methicillin-resistant Staphylococcus aureus (MRSA) infection are associated with unfavorable outcomes. Aim To reveal the risk factors, sensitivity to antibiotics, and outcome of MRSA bacteremia in infants and children with sepsis. Settings and design A prospective observational cross-sectional study was performed in Mansoura University Children’s Hospital from March 2023 to January 2024. Patients and methods The study involved infants and children diagnosed with sepsis and confirmed SAB on blood culture. Demographic data and blood culture with antibiotics sensitivity were recorded. Risk factors for MRSA bacteremia, antibiotic susceptibility, and mortality are the study outcomes. Statistical analysis used Multivariate analysis was done to assess the predictors of MRSA infection. Results A total of 319 patients were admitted with sepsis. SAB was isolated from 133 patients, 99 (74.4%) with methicillin-sensitive Staphylococcus aureus and 34 (25.6%) with MRSA. Risk factors for the development of MRSA infection are the presence of hospital-acquired infection (adjusted odds ratio=6.95), prolonged mechanical ventilation, presence of shock, and decreased body weight. Mortality was higher in the MRSA group (20.6 vs. 6.1%, P=0.014) with prolonged median duration of pediatric intensive care unit admission (19.5 vs. 14 days; P=0.040). Linezolid and teicoplanin were the most efficient antibiotics used in MRSA with 100% sensitivity in-vitro cultures, whereas resistance to erythromycin (90.9%) was documented. Conclusion MRSA poses a significant threat in pediatric sepsis. The presence of hospital-acquired infection and prolonged mechanical ventilation are the chief predictors of MRSA infection. Linezolid and teicoplanin are the most sensitive antibiotics used in MRSA management.

Predictors of bacteremia in febrile infants under 3 months old in the pediatric emergency department

IntroductionFever may serve as the primary indicator of underlying infection in children admitted to the pediatric emergency department (PED), especially in high-risk young infants. This study aimed to identify early clinical factors that could help predict bacteremia in young febrile infants.MethodsThe study included infants under 90 days of age who were admitted to the PED due to fever. Patients were divided into two groups based on the presence or absence of bacteremia and further divided into three age groups: (1) less than 30 days, (2) 30 to 59 days, and (3) 60 to 90 days. Several clinical and laboratory variables were analyzed, and logistic regression and receiver operating characteristic (ROC) analyses were used to identify potential risk factors associated with bacteremia in young febrile infants.ResultsA total of 498 febrile infants were included, of whom 6.4% were diagnosed with bacteremia. The bacteremia group had a higher body temperature (BT) at triage, especially in neonates, higher pulse rates at triage, longer fever subsidence time, longer hospital stays, higher neutrophil counts, and higher C-reactive protein (CRP) levels than those of the non-bacteremia group. ROC analysis showed that the best cut-off values for predicting bacteremia in infants with pyrexia were a BT of 38.7 °C, neutrophil count of 57.9%, and CRP concentration of 53.8 mg/L.ConclusionsA higher BT at triage, increased total neutrophil count, and elevated CRP levels may be useful for identifying bacteremia in young febrile infants admitted to the PED.

Urinary Predictors of Bacteremia in Febrile Infants with Urinary Tract Infection

<strong>Background:</strong> Predicting the risk of bacteremia in febrile infants with urinary tract infection (UTI) remains a diagnostic challenge. Prior studies have focused on the utility of blood biomarkers in predicting the risk of bacteremia in febrile infants, the role of urinary components in predicting bacteremia remain unexplored. This study aims to evaluate the utility of components of urinalysis (UA) in predicting bacteremia in febrile infants &lt; 3 and 3–24 months with UTI. <strong>Methods:</strong> We reviewed records of 2000 febrile children 0–24 months with UTI, seen over a 6-year-period in the pediatric emergency department. We defined UTI as positive urine culture, based on the 2016 AAP thresholds. Descriptive, chi-square, and logistic regression analyses were performed as appropriate, including test probabilities (sensitivity [Sn], specificity [Sp], and negative predictive value [NPV]) to evaluate the bacteremia predictive probabilities of components of UA using SAS-9.4®. <strong>Results:</strong> Of 813 febrile infants with UTI who had blood cultures, 82 (10.1%) had bacteremia. There was no statistically significant difference between compared groups in terms of sex, ethnicity, or urine collection method. Infants &lt; 3 months had significantly higher prevalence of bacteremia compared to infants 3–24 months (14.3% vs. 4.3%, p &lt; 0.0001). Urinary predictors of bacteremia in infants &lt; 3 months include bacteriuria-(pOR:2.3, p = 0.010, Sn-80.0%, NPV-91.8%, Sp-36.8%), pyuria-(pOR-6.7, p = 0.031, Sn-98.4%, NPV-97.4%, Sp-10.0%), and growth of E. coli in urine culture- (pOR-9.8, p = 0.0006, Sn-98.5%, NPV-98.1%, Sp-12.9%). There were no UA predictors of bacteremia among infants 3–24 months. <strong>Conclusion:</strong> Components of UA may be useful in predicting bacteremia in febrile infants &lt; 3 months with UTI. Among infants &lt; 3 months with UTI, potential predictors of bacteremia were bacteriuria, pyuria, and growth of E. coli on urine culture. Urinary components did not predict bacteremia in infants 3–24-months.

Utility of the systemic immune-inflammation index to predict serious bacterial infections in infants with fever without a source

ABSTRACT Introduction This study analyzed the utility of the systemic immune-inflammation index (SII) in predicting serious bacterial infections (SBIs) in infants with fever without a source (FWS). Methods Infants (aged 1–4 months) evaluated in the pediatric emergency department for FWS were divided into two groups: with SBI and without SBI. The efficacy of inflammatory markers in predicting SBI was compared. Results The study included 223 infants with a mean age of 76.65 ± 25.42 days; 62 (27.8%) of them were included in the SBI group, and all of them were diagnosed with a urinary tract infection (UTI). The hospitalization rate and length of hospital stay were significantly higher in UTI patients (p < 0.001 for each). The mean SII was 795.76 ± 475.85 in the SBI group and 318.24 ± 300.70 in the non-SBI group, and there was a significant difference between the groups (p < 0.001). In diagnosis of SBI, the area under the curve values were found to be 0.89 [95% confidence interval (CI): 0.85–0.94] for C-reactive protein (CRP), 0.86 (95% CI: 0.81–0.91) for absolute neutrophil count (ANC), 0.84 (95% CI: 0.78–0.89) for the SII, and 0.81 (95% CI: 0.74–0.87) for WBC. In the multivariate logistic regression analysis, high CRP and SII values were found to be predictive factors for UTI without bacteremia (p < 0.001 and p = 0.008, respectively). Conclusion We found that high CRP and SII values could be predictive for UTI without bacteremia in infants with FWS. The SII may be preferred because it can be easily calculated using the hemogram results, is not accompanied by extra costs, and does not require further blood collection.

Diagnostic accuracy of Yale observational scale in bacteremia in infants and children.

Bacteremia is the presence of viable bacteria in the circulating blood. Bacteremia is diagnosed by blood culture. Yale Observation Scale (YOS) is a scale consisting of six observational items originally and is validated in young febrile children to detect serious illness. If YOS found to be highly accurate, it will help us to design a protocol for early screening and diagnosis of bacteremia in infants so that patient’s morbidity and mortality can be minimized by early treatment. Objectives: To determine the diagnostic accuracy of Yale Observation Scale (YOS) for diagnosing bacteremia, taking blood culture as gold standard. Study Design: Cross-Sectional Validation study. Setting: Department of Pediatrics, D.H.Q Hospital, Faisalabad. Period: 26th May, 2016 to 25th November, 2016. Material &amp; Methods: One hundred and five patients suffering from fever&gt;38 0C, having age from 3-36 months were included in the study. Patients already taking antibiotics, immune compromised, patients with signs and symptoms of malaria or viral infections were excluded. YOS was calculated and blood culture was performed in all patients to diagnose bacteremia. Results: Out of 105 patients, mean age was 12.9±8.24 months. There were 55(52.4%) male and 50(47.6%) female patients. Sensitivity of YOS in diagnosing bacteremia was 90.63%, specificity 79.45%, PPV 65.91%, NPV 95.08% and diagnostic accuracy was 82.86%. Conclusion: YOS can be used as a key diagnostic tool in detecting bacteremia. So, by using this tool many cases in the rural areas can be diagnosed and managed early.

Factores de riesgo asociados a bacteriemia en lactantes. Servicio de Clínicas Pediátricas. 2019

Introducción: la bacteriemia no tiene nada que ver con algo tóxico. Se considera una etapa temprana de la sepsis. Objetivo: identificar algunos factores de riesgo que se asociaron a bacteriemia en lactantes ingresados en el servicio de clínicas pediátricas del Hospital Provincial Pediátrico Docente “General Milanés” en el período comprendido del 1ro enero al 31 diciembre 2019, en Granma. Método: se realizó un estudio observacional analítico de caso y control que investigó la asociación entre la bacteriemia y factores de riesgo relacionados con la edad, sexo, desnutrición, bajo peso al nacer, prematuridad, no lactancia materna exclusiva, uso previo de antimicrobianos y hospitalización reciente. Se seleccionaron 48 casos y 144 controles. Se utilizaron métodos teóricos y empíricos y se calculó el Odd Ratio. Resultados: en el análisis univariado la edad (OR=2,51, IC= 1,28 - 4,91; p=0,01), la desnutrición (OR=30,88, p=0,00; IC=8,28-115,17), la prematuridad (OR=71,51, p=0,00; IC=13,55-77,35), el bajo peso al nacer (OR = 6,90, p = 0,01 IC=3,27-14,58), la no lactancia materna exclusiva (OR=6,90, IC=3,15-15,12; p=0,00), el uso previo de antimicrobianos (OR=19,67, IC=7,03-55,06, p=0,00) y la hospitalización reciente (OR=16,75, IC=6,45-43,40; p=0,00) contribuyeron al riesgo de bacteriemia en lactantes. El sexo no tuvo relación estadísticamente significativa (OR=1,55, IC= 0,81-2,98; p= 0,24). Conclusiones: La hospitalización reciente y la desnutrición fueron los de mayor riesgo. Se concluye que con los valores del modelo de la regresión logística binaria, se podrá estimar el riesgo de padecer esta enfermedad.

Prevalence of Occult Bacteremia in Infants With Very High Fever Without a Source.

We carried out a prospective registry-based cohort study at the emergency department of 363 previously healthy well-appearing infants 3-24 months of age with fever without a source ≥40.5°C based on local protocol. Four were diagnosed with occult bacteremia (1.1%; 95% confidence interval: 0-2.2). Recommendations for nontesting for occult bacteremia screening in these children may have to be reconsidered when fever ≥40.5°C. Larger studies are needed to confirm these results.

True Versus False Bacteremia in Infants and Children Less Than 3 Years of Age.

The objective of this study was to examine patient history as well as clinical and laboratory features associated with true bacteremia versus false bacteremia in previously healthy febrile children ages 0 to 36 months in the era of polyvalent conjugate pneumococcal immunization. Using retrospective chart review, we examined history, physical examination, and laboratory characteristics associated with true and false bacteremia. We included subjects under 3 years old, with a positive blood culture obtained in the emergency department or clinic from July 2011 to July 2013, and fever defined as a temperature of greater than or equal to 100.4°F by history or examination. We excluded those with a previously known underlying disease process that could increase the risk for positive blood culture, for example, immunodeficiency, cancer, cystic fibrosis, or significant skin disorders such as severe eczema, as well as patients with any indwelling central line, shunt, or other implanted device, or recent hospitalization for a febrile illness. Thirty subjects (24%) had true bacteremia, and 97 (76%) had false bacteremia. In the multivariable logistic regression analysis, exposure to sick contacts (odds ratio, 0.1; 95% confidence interval, 0.01-0.6; P = 0.01) and increased hours to positive blood culture (odds ratio, 0.8; 95% confidence interval, 0.8-0.9; P < 0.001) remained significant factors associated with false bacteremia. Age, maximum reported temperature, and reported days of fever were not associated with true bacteremia. We found that previously healthy children with true bacteremia are more likely to grow bacteria faster on blood culture and lack exposure to sick contacts than children with false bacteremia.

Salmonella enterica serovars Panama and Arechavaleta: Risk Factors for Invasive Non-Typhoidal Salmonella Disease in Guadeloupe, French West Indies.

A retrospective study was conducted to identify the risk factors associated with Salmonella enterica bacteremia in infants and children in Guadeloupe, French West Indies. The 171 patients with S. enterica infection seen between 2010 and 2014 included 155 (90.6%) with acute gastroenteritis, of whom 42 (27.1%) had concomitant bacteremia, and 16 (9.4%) with primary bacteremia. Most cases (97.7%) were in infants and children with no underlying health condition. Two subspecies were recovered: enterica (N = 161, 94.2%) and houtenae (N = 10, 5.8%). All but one (serovar Typhi) were non-typhoidal Salmonella. The most common serovars were Panama (N = 57, 33.3% of isolates) and Arechavaleta (N = 28, 16.4%). Univariate analysis showed a strong association only between age > 6 months and infection with the Panama or Arechavaleta serovar (P = 0.002). The rate of resistance to all classes of antibiotics during the study period was low (< 15%); however, the detection of one extended-spectrum beta-lactamase-producing S. enterica strain highlights the need for continued monitoring of antimicrobial drug susceptibility. Infection with Panama (P < 0.001) or Arechavaleta (P < 0.001) serovar was significantly associated with bacteremia in a multivariate analysis. These serovars are probably poorly adapted to humans or are more virulent. A delay between onset of symptoms and hospital admission > 5 days (P = 0.01), vomiting (P = 0.001), and increased respiratory rate (P = 0.001) contributed independently to bacteremia in the multivariate analysis. Thus, if non-typhoidal infection is suspected, blood should be cultured and antibiotic treatment initiated in all patients who meet these criteria.

Bacteremia, without Endocarditis, due to Streptococcus gallolyticus Subspecies gallolyticus in an Infant with Tetralogy of Fallot

Abstract Streptococcus gallolyticus subspecies gallolyticus (SGSG) is a rare cause of bacteremia in infants. We are reporting a case of bacteremia without endocarditis in a patient affected by tetralogy of Fallot. In the suspect of cerebral involvement, a brain image study might be useful to rule out brain abscesses or embolism. When antibiotic treatment is promptly started, prognosis is good, even with only 2 weeks of effective antibiotic therapy.

Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger

To describe the current epidemiology of bacteremia in febrile infants 60 days of age and younger in the Pediatric Emergency Care Applied Research Network (PECARN). We conducted a planned secondary analysis of a prospective observational study of febrile infants 60 days of age and younger presenting to any of 26 PECARN emergency departments (2008 to 2013) who had blood cultures obtained. We excluded infants with significant comorbidities or critically ill appearance. The primary outcome was prevalence of bacteremia. Of 7,335 screened infants, 4,778 (65.1%) had blood cultures and were enrolled. Of these patients, 84 had bacteremia (1.8%; 95% confidence interval [CI] 1.4% to 2.2%). The prevalence of bacteremia in infants aged 28 days or younger (47/1,515) was 3.1% (95% CI 2.3% to 4.1%); in infants aged 29 to 60 days (37/3,246), 1.1% (95% CI 0.8% to 1.6%). Prevalence differed by week of age for infants 28 days of age and younger (0 to 7 days: 4/156, 2.6%; 8 to 14 days: 19/356, 5.3%; 15 to 21 days: 15/449, 3.3%; and 22 to 28 days: 9/554, 1.6%). The most common pathogens were Escherichia coli (39.3%; 95% CI 29.5% to 50.0%) and group B streptococcus (23.8%; 95% CI 16.0% to 33.9%). Bacterial meningitis occurred in 19 of 1,515 infants 28 days of age and younger (1.3%; 95% CI 0.8% to 2.0%) and 5 of 3,246 infants aged 29 to 60 days (0.2%; 95% CI 0.1% to 0.4%). Of 84 infants with bacteremia, 36 (42.9%; 95% CI 32.8% to 53.5%) had urinary tract infections (E coli 83%); 11 (13.1%; 95% CI 7.5% to 21.9%) had bacterial meningitis. The prevalence of bacteremia and meningitis among febrile infants 28 days of age and younger is high and exceeds that observed in infants aged 29 to 60 days. E coli and group B streptococcus are the most common bacterial pathogens.

Risk factors for persistent bacteremia in infants with catheter-related bloodstream infection due to coagulase-negative Staphylococcus in the neonatal intensive care unit.

Coagulase-negative Staphylococcus (CoNS) is the predominant cause of catheter-related bloodstream infections (CRBSI). Infants in neonatal intensive care units (NICU) often suffer from CoNS CRBSI, which are often refractory to treatment. We sought to evaluate risk factors for developing persistent bacteremia due to CoNS CRBSI in infants, in order to identify those who require early aggressive management. We conducted a retrospective case-control study of infants in the NICU who developed CRBSI due to CoNS. Patient demographics, condition and management of CRBSI were compared between those with persistent and non-persistent bacteremia. Furthermore, prognosis of infants in the NICU after CoNS CRBSI was evaluated. Seventy six episodes of CRBSI, including 17 persistent bacteremia and 59 non-persistent bacteremia, were analyzed. In univariate analyses, persistent bacteremia was significantly associated with corrected age equivalent to gestational age of 22-28weeksat onset of CRBSI [Odds ratio (OR)=4.33; P=0.04], platelet count <100,000/μL (OR=11.5; P<0.001), use of vasopressor (OR=5.38; P=0.003), and delayed CVC removal (OR=6.25; P=0.003). In multivariate analysis, persistent bacteremia was significantly associated with platelet count <100,000/μL (OR=7.80; P=0.007), and delayed CVC removal (OR=5.07; P=0.03). Infants with persistent bacteremia tended to have a lower survival rate after CoNS CRBSI, however this was not statistically significant (P=0.21). Early CVC removal should be considered for the treatment of CRBSI due to CoNS in infants with platelet counts of less than 100,000/μL.

Bacteremia in Children Hospitalized with Respiratory Syncytial Virus Infection.

BackgroundThe risk of bacteremia is considered low in children with acute bronchiolitis. However the rate of occult bacteremia in infants with RSV infection is not well established. The aim was to determine the actual rate and predictive factors of bacteremia in children admitted to hospital due to confirmed RSV acute respiratory illness (ARI), using both conventional culture and molecular techniques.MethodsA prospective multicenter study (GENDRES-network) was conducted between 2011–2013 in children under the age of two admitted to hospital because of an ARI. Among those RSV-positive, bacterial presence in blood was assessed using PCR for Meningococcus, Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus, in addition to conventional cultures.Results66 children with positive RSV respiratory illness were included. In 10.6% patients, bacterial presence was detected: H. influenzae (n = 4) and S. pneumoniae (n = 2). In those patients with bacteremia, there was a previous suspicion of bacterial superinfection and had received empirical antibiotic treatment 6 out of 7 (85.7%) patients. There were significant differences in terms of severity between children with positive bacterial PCR and those with negative results: PICU admission (100% vs. 50%, P-value = 0.015); respiratory support necessity (100% vs. 18.6%, P-value < 0.001); Wood-Downes score (mean = 8.7 vs. 4.8 points, P-value < 0.001); GENVIP scale (mean = 17 vs. 10.1, P-value < 0.001); and length of hospitalization (mean = 12.1 vs. 7.5 days, P-value = 0.007).ConclusionBacteremia is not frequent in infants hospitalized with RSV respiratory infection, however, it should be considered in the most severe cases.

Current management of occult bacteremia in infants

ObjectivesTo summarize the main clinical entities associated with fever without source (FWS) in infants, as well as the clinical management of children with occult bacteremia, emphasizing laboratory tests and empirical antibiotics. SourcesA non‐systematic review was conducted in the following databases–PubMed, EMBASE, and SciELO, between 2006 and 2015. Summary of the findingsThe prevalence of occult bacteremia has been decreasing dramatically in the past few years, due to conjugated vaccination against Streptococcus pneumoniae and Neisseria meningitidis. Additionally, fewer requests for complete blood count and blood cultures have been made for children older than 3 months presenting with FWS. Urinary tract infection is the most prevalent bacterial infection in children with FWS. Some known algorithms, such as Boston and Rochester, can guide the initial risk stratification for occult bacteremia in febrile infants younger than 3 months. ConclusionsThere is no single algorithm to estimate the risk of occult bacteremia in febrile infants, but pediatricians should strongly consider outpatient management in fully vaccinated infants older than 3 months with FWS and good general status. Updated data about the incidence of occult bacteremia in this environment after conjugated vaccination are needed.

Current management of occult bacteremia in infants

ObjectivesTo summarize the main clinical entities associated with fever without source (FWS) in infants, as well as the clinical management of children with occult bacteremia, emphasizing laboratory tests and empirical antibiotics. SourcesA non-systematic review was conducted in the following databases – PubMed, EMBASE, and SciELO, between 2006 and 2015. Summary of the findingsThe prevalence of occult bacteremia has been decreasing dramatically in the past few years, due to conjugated vaccination against Streptococcus pneumoniae and Neisseria meningitidis. Additionally, fewer requests for complete blood count and blood cultures have been made for children older than 3 months presenting with FWS. Urinary tract infection is the most prevalent bacterial infection in children with FWS. Some known algorithms, such as Boston and Rochester, can guide the initial risk stratification for occult bacteremia in febrile infants younger than 3 months. ConclusionsThere is no single algorithm to estimate the risk of occult bacteremia in febrile infants, but pediatricians should strongly consider outpatient management in fully vaccinated infants older than 3 months with FWS and good general status. Updated data about the incidence of occult bacteremia in this environment after conjugated vaccination are needed.

Diagnosis and management of bacteremic urinary tract infection in infants.

To report the prevalence of bacteremia by age in a sample of infants<1 year of age with urinary tract infections (UTIs), to compare characteristics of infants with UTIs with and without bacteremia, and to describe treatment courses and 30-day outcomes in infants with UTIs with and without bacteremia. We used a retrospective cross-sectional design to determine the prevalence of bacteremia in infants with UTIs at our institution. A double cohort design matching for age and gender was used to compare clinical characteristics and outcomes between infants with bacteremic versus nonbacteremic UTIs. We identified 1379 UTIs, with blood cultures obtained in 52% of cases. The prevalence of bacteremia was 4.1% (95% confidence interval 3.1%-5.3%) for all UTIs and 8% (95% confidence interval 6.1%-10.2%) for UTIs in which blood culture was obtained. Fifty-five infants with bacteremic UTIs were compared with 110 infants with nonbacteremic UTIs. Except for minor differences in the urinalysis and serum band count, there were no significant differences in clinical presentation between the 2 groups. Bacteremic infants received longer parenteral treatment courses than nonbacteremic infants (mean 6.7 vs 2.4 days, P<.001). Treatment courses in the bacteremic group were variable and predicted by age but not severity of illness. No bacteremic infant had recurrent UTI or bacteremia with the same organism within 30 days of discharge. Treatment was variable but outcomes were excellent in infants with bacteremic UTIs.

First case report of blood and urine cultures positive bacteraemia by Salmonella enterica serotype Choleraesuis from India

Introduction: Non‐typhoidal Salmonella (NTS) are commonly implicated in causing bacteraemia in infants, the elderly and immunosuppressed individuals in sub‐Saharan African countries. However, NTS bacteraemia in otherwise healthy adults from India has been rarely reported. Here, we report a case of bacteraemia caused by Salmonella enterica serovar Choleraesuis (S. Choleraesuis), isolated simultaneously from the blood and urine of an adult febrile patient from Kolkata, India. Case Presentation: A middle‐aged man was admitted to a private hospital in Kolkata with clinical suspicion of acute enteric fever on 25 October 2013. His blood report showed neutropenia and mild thrombocytopenia, with an elevated C‐reactive protein level. The Widal test was negative. S. Choleraesuis isolates were grown simultaneously by microbiological culture of blood and urine samples. The patient recovered without complications following antibiotic therapy. On further characterization, both of the S. Choleraesuis isolates showed identical antibiotic‐susceptibility patterns and virulence‐gene, plasmid and PFGE profiles, confirming their clonality (100% similarity). Conclusion: This is the first report of S. Choleraesuis bacteraemia associated with a human infection in India. The identification and reporting of uncommon Salmonella serovars from various countries are important for understanding the global epidemiology of salmonellosis.

Enterobacter cloacae septicaemia complicating rotavirus gastroenteritis: a case report

Rotavirus infections are a common cause of gastroenteritis in infants and young children worldwide. Although rotavirus gastroenteritis is usually self-limiting in healthy infants, approximately 33% of cases of severe diarrhoea require hospitalization (1). Small intestinal epithelium dysfunction during rotavirus gastroenteritis is well-documented. Enteric Gram-negative bacteraemia as a complication of rotavirus-associated gastroenteritis has been reported in healthy children (2). It is believed that steroid treatment for any purpose may increase the risk of invasion of the mucosa by endogenous enteric bacterial flora and gastrointestinal mucosal damage via rotavirus infection. There are only 2 reported cases of secondary enteric Gram-negative bacteraemia in infants with rotavirus infection who were treated with corticosteroids for panhypopituitarism and congenital adrenal hyperplasia (3). In this paper we report the case of a patient with nosocomial rotavirus-associated gastroenteritis complicated by Enterobacter cloacae bacteraemia who was treated with adrenocorticotrophic hormone (ACTH) for infantile spasm.