Characteristics of First UTI With Fever in Children
Characteristics of First UTI With Fever in Children
Background: Our objective is to provide the clinical characteristics, uropathogen frequencies, and antimicrobial resistance rates of first urinary tract infection (UTI) diagnosed in febrile Belgian children. The ability of noninvasive ultrasound to detect renal abnormalities and vesicoureteral reflux (VUR) in these patients was also assessed.
Methods: We prospectively followed (median, 20 months) 209 children treated for first febrile UTI. Renal ultrasound (US) and voiding cystourethrography examinations were performed in all patients.
Results: Among these children, 63% were females and 37% were males, and 75% of them had their first UTI before the age of 2 years. The most common causative agent was Escherichia coli (91% of cases) with high rate resistance to ampicillin (58%) and trimethoprim/sulfamethoxazole (38%). Of these children, 25% had evidence of VUR (15 boys and 38 girls). VUR was of low grade in 85% of cases. The overall performance of renal US as a diagnostic test to detect significant uropathies excluding low-grade VUR was excellent; the sensitivity attained 97% and the specificity 94%.
Conclusion: Girls represent 63% of cases with first UTI. For 91% of UTIs, Escherichia coli is held responsible with a high rate of resistance to ampicillin and trimethoprim/sulfamethoxazole. US is an excellent screening tool that allows avoidance of unjustified voiding cystourethrography studies.
Urinary tract infection (UTI) is one of the most common infections diagnosed in outpatients and hospitalized pediatric patients, with 8% of girls and 2% of boys experiencing at least one UTI by the age of 7 years. Renal ultrasonography (US) and voiding cystourethrography (VCUG) examinations have been standard diagnostic tools for children with first UTI to identify possible structural or functional abnormalities of the urinary tract, such as vesicoureteral reflux (VUR). These abnormalities were thought to be important to detect as they have been suspected to predispose the child to repeated episodes of pyelonephritis and potentially irreversible renal damage.
There is growing concern regarding the resistance of uropathogens to antibiotics, because of the increasing number of failures of empiric treatments administered according to national and international guidelines for children.
The major aim of this prospective study was to describe the characteristics and the clinical evolution of first UTI that was diagnosed by systematic screening in the emergency department of febrile Belgian children in whom UTI was considered a possibility on clinical grounds. The second aim of this study was to characterize the frequencies of uropathogens and their antimicrobial resistance rates to evaluate the options for empiric antibiotic therapy for UTI in Belgian children. Finally, we investigated the diagnostic performance of renal US to detect significant congenital abnormalities of the urinary tract that might predispose children to recurrent infections.
Abstract and Introduction
Abstract
Background: Our objective is to provide the clinical characteristics, uropathogen frequencies, and antimicrobial resistance rates of first urinary tract infection (UTI) diagnosed in febrile Belgian children. The ability of noninvasive ultrasound to detect renal abnormalities and vesicoureteral reflux (VUR) in these patients was also assessed.
Methods: We prospectively followed (median, 20 months) 209 children treated for first febrile UTI. Renal ultrasound (US) and voiding cystourethrography examinations were performed in all patients.
Results: Among these children, 63% were females and 37% were males, and 75% of them had their first UTI before the age of 2 years. The most common causative agent was Escherichia coli (91% of cases) with high rate resistance to ampicillin (58%) and trimethoprim/sulfamethoxazole (38%). Of these children, 25% had evidence of VUR (15 boys and 38 girls). VUR was of low grade in 85% of cases. The overall performance of renal US as a diagnostic test to detect significant uropathies excluding low-grade VUR was excellent; the sensitivity attained 97% and the specificity 94%.
Conclusion: Girls represent 63% of cases with first UTI. For 91% of UTIs, Escherichia coli is held responsible with a high rate of resistance to ampicillin and trimethoprim/sulfamethoxazole. US is an excellent screening tool that allows avoidance of unjustified voiding cystourethrography studies.
Introduction
Urinary tract infection (UTI) is one of the most common infections diagnosed in outpatients and hospitalized pediatric patients, with 8% of girls and 2% of boys experiencing at least one UTI by the age of 7 years. Renal ultrasonography (US) and voiding cystourethrography (VCUG) examinations have been standard diagnostic tools for children with first UTI to identify possible structural or functional abnormalities of the urinary tract, such as vesicoureteral reflux (VUR). These abnormalities were thought to be important to detect as they have been suspected to predispose the child to repeated episodes of pyelonephritis and potentially irreversible renal damage.
There is growing concern regarding the resistance of uropathogens to antibiotics, because of the increasing number of failures of empiric treatments administered according to national and international guidelines for children.
The major aim of this prospective study was to describe the characteristics and the clinical evolution of first UTI that was diagnosed by systematic screening in the emergency department of febrile Belgian children in whom UTI was considered a possibility on clinical grounds. The second aim of this study was to characterize the frequencies of uropathogens and their antimicrobial resistance rates to evaluate the options for empiric antibiotic therapy for UTI in Belgian children. Finally, we investigated the diagnostic performance of renal US to detect significant congenital abnormalities of the urinary tract that might predispose children to recurrent infections.
Source...