Urinary Tract Infection In Infants Research Articles

Genetic determinants of renal scarring in children with febrile UTI.

Febrile urinary tract infections (UTIs) are among the most severe bacterial infections in infants, in which a subset of patients develops complications. Identifying infants at risk of recurrent infections or kidney damage based on clinical signs is challenging. Previous observations suggest that genetic factors influence UTI outcomes and could serve as predictors of disease severity. In this study, we conducted a nationwide survey of infant genotypes to develop a strategy for infection management based on individual genetic risk. Our aims were to identify genetic susceptibility variants for renal scarring(RS) and genetic host factors predisposing to dilating vesicoureteral reflux (VUR) and recurrent UTIs. To assess genetic susceptibility, we collected and analyzed DNA from blood using exome genotyping. Disease-associated genetic variants were identified through bioinformatics analysis, including allelic frequency tests and odds ratio calculations. Kidney involvement was defined using dimercaptosuccinic acid (DMSA) scintigraphy. In this investigation, a cohort comprising 1087 infants presenting with their first episode of febrile UTI was included. Among this cohort, a subset of 137 infants who underwent DMSA scanning was subjected to gene association analysis. Remarkable genetic distinctions were observed between patients with RS and those exhibiting resolved kidney involvement. Notably, the genetic signature indicative of renal scarring prominently featured mitochondrial genes. In this nationwide study of genetic susceptibility to RS after febrile UTIs in infancy, we identified a profile dominated by mitochondrial polymorphisms. This profile can serve as a predictor of future complications, including RS and recurrent UTIs.

Decreased incidence of urinary tract infections in febrile infants aged ≤60 days during COVID-19 pandemic.

To investigate the incidence rate of urinary tract infections (UTIs) among febrile infants aged ≤60 days before, during, and after the COVID-19 pandemic. We conducted a retrospective study in 2 Swedish paediatric emergency departments between 2014 and 2022. We included full-term infants aged ≤60 days with fever without source. We calculated the annual incidence rate of UTI per 1000 births. We included 1589 full-term infants with fever without source. In 2020, 89 infants were evaluated in the emergency department versus 203-259 in 2017-2019. In 2020, the incidence rate of UTI was 1.43 per 1000 births/year versus 2.18-2.37 in 2017-2019. The median age, sex, fever duration, and urine testing were similar between the years 2017 and 2020. The number of febrile infants who presented to the paediatric emergency department and the incidence rate of UTIs decreased in 2020. This decrease might imply a systematic misdiagnosis of UTIs in infants with febrile viral infections. A more selective urine testing approach for febrile, previously healthy, infants should be considered to mitigate UTI misdiagnosis and its potential harmful effects.

Improving Management: Novel Guidelines for Diagnosing Urinary Tract Infection in Infants.

The diagnosis of urinary tract infection (UTI) in the pediatric field remains a topic of debate. In 2011, the American Academy of Pediatrics (AAP) introduced new guidelines for the diagnosis of UTI in patients aged 2-24 months. However, concerns were raised regarding these guidelines. This is a retrospective data extraction study that included patients aged 0-6 months who were examined in the pediatric emergency department between 2016 and 2021 and had a urine culture. For each patient, we recorded the diagnosis documented in the medical records, the diagnosis based on the AAP and Israeli guidelines, and the diagnosis according to our 2 proposed protocols. We then compared the percentage of UTI diagnoses according to each diagnostic guideline. A total of 1432 patients under the age of 6 months underwent urine culture testing during the study period. A total of 83 (5.81%) of these patients were diagnosed with UTI according to the AAP guidelines, 184 of the patients (12.8%) were diagnosed with UTI according to the Israeli guidelines, 102 (7.1%) and 109 (7.6%) of the patients were diagnosed with UTI according to our first and second proposed guidelines, respectively. We propose a new diagnostic method (guidelines II) that is suitable for patients older than 2 months, with obligatory criteria of abnormal urine test and a lower threshold for the colony count required for diagnosis compared to the AAP guidelines. Further research is required to examine the sensitivity and specificity of our proposed guidelines, so it may replace the current diverse guidelines.

Risk factors for urinary tract infection in infants with unexplained hyperbilirubinemia: a single center case-control study

BackgroundUrinary tract infection (UTI) is a potential cause of neonatal jaundice. Nevertheless, there remains a lack of consensus regarding appropriate screening practices for UTI in infants with hyperbilirubinemia. This study aimed to analyze a group of jaundiced infants to assess the prevalence of UTI, explore potential risk factors, and examine the impact of UTI on the course and severity of neonatal jaundice.MethodsThis retrospective case-control study was conducted on 150 jaundiced infants (aged < 8 weeks) without a known etiology in the hyperbilirubinemia work-up. All subjects underwent phototherapy treatment and UTI screening by catheterization. They were then classified into UTI and non-UTI groups based on urine culture results, with a positive urine culture indicating the growth of ≥10,000 colony-forming units. The clinical characteristics and jaundice-related parameters of both groups were analyzed.ResultsAmong the 150 jaundiced patients, the prevalence of UTI was 29%. There was a significantly higher male predominance in the UTI group, and patients with UTI also had a significantly longer duration of hospitalization compared to those without UTI. Significant risk factors associated with UTI in jaundiced infants included male gender and a peak total bilirubin level higher than 18 mg/dl during hospitalization. The most common pathogens identified in urine culture were Escherichia coli (41.9%) and Enterococcus faecalis (30.2%).ConclusionIn cases of neonatal jaundice where the underlying cause is not evident, screening for UTI should be performed, particularly when associated risk factors or inadequate response to phototherapy is present.

Abnormal Development of Microbiota May Be a Risk Factor for Febrile Urinary Tract Infection in Infancy.

Febrile urinary tract infection (fUTI) is common in infants, but specific risk factors for developing it remain unclear. As most fUTIs are caused by ascending infections of intestinal bacteria, dysbiosis-an imbalance in gut microbial communities-may increase fUTI risk. This study was conducted to test the hypothesis that abnormal development of gut microbiota during infancy increases the risk of developing fUTI. Stool samples were collected from 28 infants aged 3-11 months with first-onset fUTI (fUTI group) and 51 healthy infants of the same age (HC group). After bacterial DNA extraction, 16S rRNA expression was measured and the diversity of gut microbiota and constituent bacteria were compared between the two groups. The alpha diversity of gut microbiota (median Shannon index and Chao index) was significantly lower in the fUTI group (3.0 and 42.5) than in the HC group (3.7 and 97.0; p < 0.001). The beta diversity also formed different clusters between the two groups (p < 0.001), suggesting differences in their microbial composition. The linear discriminant analysis effect size showed that the fUTI group proportionally featured significantly more Escherichia-Shigella in the gut microbiota (9.5%) than the HC group (3.1%; p < 0.001). In summary, abnormal gut microbiota development during infancy may increase the risk of fUTI.

Perinatal and Other Risk Factors for Common Infections in Infancy: A Prospective Cohort Study.

Limited data from prospective cohort studies in high-income countries are available on the perinatal risk factors for common infections in children. Our hypothesis was that perinatal factors may be risk factors for infectious episodes during the first year of life. In this prospective Health and Early Life Microbiota birth cohort study of full-term infants (n = 1052) born in 2016-2018, the number and duration of infection episodes were collected online at weekly to monthly intervals. In a multivariate regression model, the main exposures were perinatal factors such as mode of delivery and intrapartum antibiotics. Environmental factors were additional exposures. The outcomes were the number and duration of infectious episodes in the first year of life. The mean number of infection episodes was 4.2 (2.9 SD). The mean duration of infection symptoms was 44 days (40 SD). Upper respiratory infections accounted for 83% of the episodes (3674/4455). Perinatal factors were not associated with the number nor the duration of infection episodes, but cesarean section was associated with an increased occurrence of urinary tract infections in infancy [adjusted odds ratio (aOR): 3.6; 95% confidence interval (CI): 1.13-11.1]. Of the additional exposures male sex (aOR: 1.1; 95% CI: 1.0-1.2) and the presence of siblings (aOR: 1.3; 95% CI: 1.2-1.4) were associated with the number of infection episodes. This prospective cohort study showed that perinatal factors, mode of delivery and intrapartum antibiotics were not associated with the risk of common infections in infancy, but cesarean delivery was associated with a risk of urinary tract infections.

Urinary Tract Infection in Infants

This cross-sectional study was conducted on 232 infants aged <1 month with proven UTI admitted to three major teaching hospitals for the period 2010-2018 to assess clinical, demographic, and laboratory findings of urinary tract infection in this age group. All information was extracted from the medical records. Urinary tract infection was defined as ≥ 50,000 colony-forming units per milliliter of a single uropathogen isolated from a catheterized or suprapubic aspiration or greater than 100,000 colony-forming units per milliliter from a midstream, clean-catch sample. The most common pathogen isolated was E. coli (78.4%), followed by Enterobacter and Klebsiella, accounting for 12.1 and 4.7% respectively. The main presenting clinical manifestation was jaundice, which was found in 54.7% of cases; it was followed by restlessness (45.6%) and fever (40%). During infancy, the signs and symptoms of UTI are often nonspecific and although urine culture is a gold standard diagnostic tool specimen collection is challenging and urine contamination is common in children, therefore it makes the diagnosis difficult. UTI in infants may indicate underlying genitourinary abnormalities; therefore, appropriate diagnosis and immediate initiation of antibiotic therapy are crucial to decrease long-term complications like renal scarring. According to our study, the most common clinical features were jaundice, restlessness, and fever, therefore it is suggested that urine culture should be performed for all infants presenting with these signs and symptoms.

A Comparison of Short Versus Long Course Intravenous Antibiotics When Treating Urinary Tract Infection in Infants

Urinary tract infections (UTIs) are a common reason for hospitalization in infants younger than 60 days, and the optimal approach to intravenous (IV) antibiotic therapy upon UTI diagnosis in this cohort is unknown. We determined whether there was an association between IV antibiotic therapy duration (long [>3 days] vs short [≤3 days]) and treatment failure via a retrospective review of infants with confirmed UTIs receiving IV antibiotics at a tertiary referral center. A total of 403 infants were included; 39% were treated with ampicillin and cefotaxime, and 34% with ampicillin and gentamycin or tobramycin. The median IV antibiotic duration was 5 (interquartile range: 3-10) days, and 5% of patients experienced treatment failure. The treatment failure rate was similar in both short- and long-course IV antibiotic groups (P > .05), and there was no significant association between treatment duration and failure. We conclude that treatment failure for infants hospitalized with UTI is uncommon and not associated with IV antibiotic duration.

Risk factors for imaging abnormalities after the first febrile urinary tract infection in infants ≤3 months old: a retrospective cohort study

ObjectivesTo assess the association of clinical factors and investigation results (blood and urine) with imaging abnormalities (ultrasound of the kidneys, ureters and bladder; dimercaptosuccinic acid scan; and/or micturating cystourethrogram) and...

Prevalence of Risk Factors of Urinary Tract Infections in Infants and Children in Arak, Iran: A Cross-sectional Study

Background: Urinary tract infection (UTI) is one of the most common childhood infections. Urinary tract infections are divided into simple and complex types. If the bladder infection is not treated, it can cause secondary kidney infections, such as acute pyelonephritis, which can lead to kidney scar or permanent kidney damage. A significant percentage of patients of any age are re-infected after antimicrobial treatments during the first six months after the first period of UTI. Objectives: This research aimed to investigate the risk factors affecting UTI in infants and children hospitalized in Arak Amir Kabir Hospital in 2017-2018 to prevent UTI and its secondary complications. Methods: In this cross-sectional study, the data collection tool was a validated questionnaire to gather the child's demographic characteristics, including age, sex, type of nutrition, circumcision, age of circumcision, as well as information about fetal birth weight, chronic maternal diseases such as diabetes and stress, and residence place. The content validation method was used to determine the validity of the checklist, and the test-retest was used for reliability. Data were analyzed by SPSS version 22 software. Results: Sixty four percent of children had the normal ultrasound, while 22% had hydronephrosis and nephrolithiasis on ultrasound. The average thickness and size of the right kidney were 71.75 and 9.11, and those of the left kidney were 9.11 and 9.50, respectively. The most common microorganism was Escherichia coli. Conclusions: Given the importance of prevention and timely diagnosis and treatment of UTI to prevent kidney injuries, it is necessary to find UTI risk factors as the first step to preventing children from secondary kidney injuries.

Effect of topical glucocorticoid in treating phimosis on urinary tract infection of vesicoureteral reflux in infants

Objective: To evaluate the effect of topical glucocorticoid in treating phimosis on urinarytract infection(UTI) of vesicoureteral reflux(VUR) in infants. Methods: Clinical data of infants with UTI diagnosed as primary VUR admitted to our hospital from January 2016 to January 2021 were retrospectively analyzed. The children were divided into three groups:the effective group (topical glucocorticoid was effective in the treatment of phimosis), the ineffective group(topical glucocorticoid was ineffective in the treatment of phimosis), and the untreated group(phimosis was not treated). Age of onset, degree of reflux, side and other indicators were compared to understand the effectiveness of topical glucocorticoid in treating phimosis, and the clinical characteristics of repeated UTI with VUR in treated phimosis and untreated phimosis. Results: A total of 544 children were included. Among them, 59 cases were treated with topical glucocorticoid for phimosis, 48 cases in the effective group, and their age was (12.5±8.4) months;11 cases in the ineffective group,and their age was (11.2±8.9) months. There were 485 cases in the untreated group, and their age was (13.1±9.3) months.The effective rate of topical glucocorticoid in the treatment of phimosis was 81.36%. There were 12 cases(12/48) of recurrent UTI in the effective group and 213 cases (213/485)of recurrent UTI in the untreated group, and the difference between the two groups was statistically significant (P=0.008). Conclusion: Treatment of phimosis with topical glucocorticoid is an effective, easy to perform, and cost-effective method, and can effectively reduce the risk of recurrent UTI in infants with primary VUR.

Microbial Etiology and Antibiotic Resistance Patterns of Urinary Tract Pathogens in Hospitalized Infants in Bahrain: A Tertiary Care Center Experience.

Introduction: Urinary tract infections (UTIs) are fairly common in infants. Early diagnosis and prompt treatment are crucial to avoid complications. However, providing appropriate antibiotic treatment is a challenge to any clinician considering the rise in the urinary pathogens that are resistant to the commonly used antibiotics especially with the emergence of extended-spectrum beta-lactamase (ESBL)-producing organisms. Consequently, this leaves the physician with limited options of antibiotic choices. This study aims to investigate the local resistance patterns of uropathogens causing UTIs in hospitalized infants in Bahrain and to provide guidance for the preferred choice of empirical antibiotic treatment.Methods: A retrospective cross-sectional study with an analysis of the medical records of infants from birth to one year of age admitted with UTIs at Salmaniya Medical Complex between June 2015 and June 2017 was conducted.Results: Data were obtained from 117 term infants (no preterm infants were included), with 80 (68.4%) being male. A total of 106 (90.6%) patients were less than six months of age. The most frequently isolated organisms were Escherichia coli found in 66 (49.6%) patients, followed by Klebsiella in 43 (32.3%). Forty-eight (36%) were ESBL-producing organisms (31 and 17 of E. coli and Klebsiella, respectively). The highest antibiotic resistance of E. coli was found against cephalosporin (55.5%), while penicillin resistance was only 19.4% and co-trimoxazole was 14.4%. Resistance rates of non-E. coli organisms were highest against cephalosporin (44.6%), followed by nitrofurantoin (19.1%) and penicillin (18.5%). The overall resistance to cephalosporin antibiotics was highest against cephalothin (a first-generation cephalosporin) (54.9%). The second highest resistance rate was demonstrated against cefuroxime (a second-generation cephalosporin) (50.5%), followed by ceftriaxone (a third-generation cephalosporin) (45.1%). Lower resistance rates were found against cefotaxime (22.3%), followed by ceftazidime (33.3%). A resistance rate of zero was found against cefepime (a fourth-generation cephalosporin). Aminoglycosides and nitrofurantoin demonstrated the lowest resistance rates among all cultured uropathogens. Among all cultures, 3.9% of the E. coli were resistant to aminoglycosides, while non-E. coli organisms showed zero resistance to aminoglycosides. Regarding the nitrofurantoin antibiotic, 19% of non-E. coli bacteria showed resistance, while only 1.7% of E. coli were resistant to this antibiotic. Zero resistance to carbapenem was found in E. coli organisms (both ESBL and non-ESBL), compared to 1.9% resistance by non-E. coli organisms (both ESBL and non-ESBL combined).Conclusion: E. coli is the predominant uropathogen causing UTI in infants with high rates of ESBL organisms in our community. Since the highest resistance was found against cephalosporins, aminoglycosides and nitrofurantoin are the preferred empirical antibiotic options for the treatment of UTIs. For infants with ESBL organisms, carbapenem antibiotics represent a good treatment option.

Infant Circumcision for Sexually Transmitted Infection Risk Reduction Globally.

<h3>Key Messages</h3> Population-based studies in high-income countries have generally failed to find protection of male circumcision (MC) against sexually transmitted infections (STIs). This stems from the overrepresentation of men who have sex with men (MSM) in national STI statistics, with inability of MC to protect against STIs during receptive anal intercourse. Studies of men from settings where MC is performed early in life showed lower prevalence of STIs in circumcised men. However, a Danish database study reported an association of early MC with an increased risk of STIs. The study’s findings were underpowered, contained questionable statistical methods, failed to consider receptive anal intercourse by MSM, and failed to adequately exclude non-ethnic Danes. Biological plausibility of infant MC in reducing infection risk is supported by its well-established ability to protect against infant urinary tract infections, as well as pathogenic bacteria and other microorganisms, across all ages. Childhood MC appears effective for protection against various specific STIs irrespective of the country where it was performed.

Emergence of Extended-Spectrum β-Lactamase-Producing Pathogens in Community-Acquired Urinary Tract Infections Among Infants at a Pediatric Emergency Department.

Extended-spectrum β-lactamase (ESBL)-producing pathogens are common among adults and are associated with extended and multiple hospitalizations. They cause urinary tract infections (UTIs) among children with known risk factors such as urinary tract abnormalities and antimicrobial prophylaxis. The emergence of UTIs caused by ESBL-producing organisms among infants has not been well characterized. We sought to describe the incidence and current clinical management of infants who were diagnosed with UTIs caused by ESBL-producing organisms at a pediatric emergency department (ED). In addition, we sought to describe risk factors associated with inpatient hospitalization for UTIs caused by ESBL-producing organisms. We retrospectively identified infants who were treated in the ED from 2013 to 2017 and who had positive urinalyses and urine cultures positive for greater than 50,000 colony-forming unit per milliliter of a single ESBL-producing urinary pathogen. We abstracted details of clinical management and known previous risk factors, including prior neonatal intensive care unit hospitalization stay, prior UTI caused by an ESBL-producing organism, and known urologic abnormalities. Forty-five UTIs caused by ESBL-producing organisms occurred in 43 patients (mean age of 5.9 months and 59% female)-ESBL Escherichia coli represented the majority (42/45). The incidence of UTIs caused by ESBL-producing organisms ranged from 0.9% to 4.5% during the 5-year study period. The 13 patients (26%) admitted from the ED were significantly younger than discharged patients (1.9 vs 6.7 months, P = 0.016) and more likely to have had prior neonatal intensive care unit hospitalizations (50% vs 15.6%, P = 0.0456). Of the 33 visits (77%) resulting in initial outpatient management, 5 were followed by readmission for parenteral antibiotic treatment. Of those who were readmitted, 40% (n = 2) were afebrile at the time of admission. The remainder (28/33) completed outpatient oral antibiotic courses guided by susceptibilities. Two patients (4%) had negative repeat urine cultures despite in vitro resistance to initial antibiotic coverage. Extended spectrum β-lactamase-producing organisms are an increasing cause of UTIs in infants presenting at a pediatric ED, and outpatient management may be reasonable for infants older than 2 months.

Egyptian pediatric clinical practice guidelines for urinary tract infections in infants and children (evidence based)

BackgroundNational evidence-based recommendations for diagnosis, treatment, imaging, and follow-up in urinary tract infection are crucial being a major health problem in pediatrics. Every region should follow international recommendations with respect to the disease local profile and available facilities for that area.MethodsBased on AGREE II (the assessment tool of practice guidelines), Egyptian CGLs used *American Academy Pediatrics, *European Association Urology, European Society Pediatric Urology, and *Asian Association Urinary tract infections as its evidence-based references. Health questions were listed for evidence base answers adopted from selected CGLs after their permission. Key statements were approved by all members and further approved by the Egyptian Pediatric Guidelines Committee after local and international external peer reviewing.Results(1) Diagnosis recommendations: Urine culture with diagnostic colony counts is essential for diagnosis. Catheter samples are important for critical cases and non-toilet-trained cases especially when they show significant bacteriuria and pyuria. (2) Treatment plan included areas of debate as choice of antibiotic, oral versus intravenous, duration, antibiotic prophylaxis considering age, disease severity, recurrence, + risk factors, and imaging reports. (3) Imaging recommendations were tailored to suit our community. Renal bladder ultrasound is important for children with febrile UTI, due to the high prevalence of congenital anomalies of the kidney and urinary tract, paucity of prenatal ultrasound, and lack of medical documentation to reflect previously diagnosed UTI or US reports. We recommend renal isotopic scan and voiding cystography for serious presentation, high-risk factors, recurrence, and abnormal US. (4) Urological consultation is recommended: in urosepsis or obstruction, male infants < 6 months. Acute basal DMSA is recommended in congenital renal hypodysplasia. Six months post-infection, US and DMSA are recommended in severe pyelonephritis and vesico-ureteric reflux, where those with abnormal US or DMSA or both should have voiding cystography. (5) Follow-up recommendations include family orientation with hazards of noncompliance and monitoring at pregnancy.ConclusionDiagnosis and treatment show strong recommendations. Imaging depends on patient assessment. Referral to a pediatric nephrologist and urologist in complicated cases is crucial. Follow-up after the age of 16 years in adult clinics is important.

Lumbar puncture in infants with urinary tract infection: Assessment of infant management in the emergency department

BackgroundNeonatal bacterial infections must be bacteriologically confirmed from laboratory samples to best adjust antibiotic therapy. Lumbar puncture (LP) has been recommended for infants younger than 1 month with suspected serious bacterial infection (SBI) to manage possible meningitis. However, the incidence of bacterial meningitis associated with other infections and particularly with urinary tract infections (UTIs) is low. Recourse to systematic LP may be less essential if infants have a UTI. We aimed (a) to determine the management and frequency of bacterial meningitis coexisting with a documented diagnosis of UTI in infants aged < 1 month who had an LP, and (b) to evaluate the management of infants in emergency admissions with suspected SBI while assessing antibiotic treatment. Methods: We conducted a retrospective single-center study from January 2010 to April 2019 including all cases of neonatal bacterial infections, and collected data on the clinical, laboratory, and radiological features. ResultsIn all, 409 infants were included in the study. Of these, 162 (39.6%) presented with a UTI and eight (2%) had bacterial meningitis. Of the infants diagnosed with UTI, 74.7% had an LP, of whom 34.7% experienced LP complications. No coexistence of UTI and bacterial meningitis was found among infants who had an LP and a documented UTI. ConclusionAlthough not all infants had an LP and a urine culture at the same time, these results show that bacterial meningitis coexisting with a confirmed UTI diagnosis in infants is rare. Furthermore, LP can be traumatic in some cases and therefore its utility should be assessed according to the clinical context.

Incidence And Characteristics Of Urinary Tract Infections Among Febrile Children In Early Childhood

Introduction: Fever is the most common cause for concern for parents and a reason to seek help from a GP or emergency centers. The high temperature in children in most cases is short-lived and is a protective reaction that stops or slows down the development of many microorganisms, stimulates the immune response, and provides rest to the sick child. Negative effects are dehydration, hypovolemia, hyperthermic seizures in childhood, hypotension to collapse. Urinary tract infections (UTIs) can occur only with fever or with fever and non-specific symptoms such as malaise, vomiting, abdominal pain, and jaundice. Antibiotic treatment for fever without a proven cause may mask an existing urinary tract infection. Aim : The aim of this article is to review the scientific literature for a period of 40 years on the incidence of UTIs in infancy and early childhood in children with fever. Methods: Analysis of Bulgarian and foreign literature sources according to the PubMed and Google Scholar databases for a period of 40 years has been conducted. Results: The analysis of the data from the scientific literature showed that the frequency of UTI varies depending on gender and age. In most studies, the incidence of UTI in febrile children under 24 months of age, both sexes, with or without additional symptoms of UTI, was between 5% and 15%. In boys, the prevalence is highest in the first 3 months of life and then shows a declining trend, while in girls the prevalence is highest in the first 12 months of life. There is evidence in the literature that fever (rectal temperature ≥ 39°C) and uncircumcised status are more likely to be linked to UTI in boys. E. coli is the most common bacterial infection in early childhood and is the leading cause of UTI in this age group. Conclusion : The GP needs to make efforts to educate parents on the diagnosis, consequences and appropriate treatment of obscure febrile conditions, and UTI should be excluded. It is necessary to pay attention to the method of measuring the temperature, the differences in the values in the different measuring points. In this aspect, the GP should perform an in-depth analysis for early diagnosis of UTI in all boys under 12 months of age and girls under 24 months of age with unexplained fever, temperature above ≥ 38°C measured rectally for 3 minutes.

Urine collection methods for infants under 3 months of age in clinical practice

Methods of urine collection used in precontinent children are a controversial issue. Definitive diagnosis of urinary tract infection (UTI) requires an uncontaminated urine culture. We aimed to describe methods used to collect urine for culture in infants under 3 months of age and compare results and contamination rates. This retrospective observational cohort study included 721 urine cultures collected from infants <3 months of age at the Hospital Universitario Infanta Sofía, Madrid, between January 2016 and December 2019. Urine cultures were compared based on collection technique, sex, and patient age. Median patient age was 36 days and 54.6% were male. In total, 592 (82.1%) samples were collected using clean-catch urine stimulation technique (CCUST), 77 (10.7%) by urethral catheterization (UC) and 52 (7.2%) by urine bag (UB). Positive cultures were obtained in 11.7% (95% confidence interval [CI] 9.1, 14.3) of CCUST samples and in 28.6% (95% CI 18.5, 38.7) of UC samples (p<0.001). The contamination rate was 13.7% (95% CI 10.9, 16.4] for CCUST, 23.1% (95% CI 11.6, 34.6) for UB and 5.2% (95% CI 0.2, 10.2) for UC, with statistically significant differences (p=0.007) between UB and UC collection. CCUST is the most commonly used method in our hospital for collecting urine in infants younger than 3 months. The contamination rate of UC is lower but not significantly different to that of CCUST. Urine collection by CCUST serves as a non-invasive alternative to UC for diagnosis of UTI in infants under 3 months of age in routine clinical practice. Graphical abstract.

Pathogen distribution and risk factors for urinary tract infection in infants and young children with retained double-J catheters.

ObjectivesTo investigate the pathogens and potential risk factors for urinary tract infection (UTI) in patients with retained double-J catheters (DJCs).MethodsIn total, 107 infants and young children with DJCs were included in this retrospective analysis. Patients were included in the infection group (n = 30) or non-infection group (n = 77), according to UTI presence or absence. The species and characteristics of pathogens were investigated, and the clinical features of the patients were recorded for further analysis.ResultsGram-negative bacilli were the most common causative pathogens (69.2%), among which Escherichia coli was most frequent (38.5%). The second most common causative pathogens were Gram-positive cocci (28.2%), among which Enterococcus faecalis was most frequent (10.3%). UTIs among patients in this study were associated with the following factors: catheter retention (long-term) (odds ratio [OR] = 2.514, 95% confidence interval [CI] = 1.176–5.373), sex (male) (OR = 2.966, 95% CI = 1.032–8.529), DJC retention (long-term) (OR = 1.869, 95% CI = 1.194–2.926), and DJC number (unilateral) (OR = 0.309, 95% CI = 0.103–0.922).ConclusionsInfants and young children with DJCs were likely to experience UTIs, mainly caused by Gram-negative bacilli. Long-term catheter retention or DJC retention, male sex, and bilateral DJC retention were risk factors for UTI.

Diagnosis and management of community-acquired urinary tract infection in infants and children: Clinical guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS).

Urinary tract infection (UTI) is the most common bacterial disease in childhood worldwide and may have significant adverse consequences, particularly for young children. In this guideline, we provide the most up-to-date information for the diagnosis and management of community-acquired UTI in infants and children aged over 90 days up to 14 years. The current recommendations given by the American Academy of Pediatrics Practice guidelines, Canadian Pediatric Society guideline, and other international guidelines are considered as well as regional variations in susceptibility patterns and resources. This guideline covers the diagnosis, therapeutic options, and prophylaxis for the management of community-acquired UTI in children guided by our local antimicrobial resistance pattern of the most frequent urinary pathogens. Neonates, infants younger than three months, immunocompromised patients, children recurrent UTIs, or renal abnormalities should be managed individually because these patients may require more extensive investigation and more aggressive therapy and follow up, so it is considered out of the scope of these guidelines. Establishment of children-specific guidelines for the diagnosis and management of community-acquired UTI can reduce morbidity and mortality. We present a clinical statement from the Saudi Pediatric Infectious Diseases Society (SPIDS), which concerns the diagnosis and management of community-acquired UTI in children.