
Eugene Leibovitz
Soroka University Medical Center, IsraelPresentation Title:
Epidemiologic, microbiologic and imaging characteristics of urinary tract infections in hospitalized infants and young children diagnosed with anatomic abnormalities of the urinary tract
Abstract
Background: Urinary tract infection (UTI) is a frequent cause of referrals to emergency rooms and hospitalization may be needed in 2-3% of cases, particularly in very young patients. A considerable number of medical conditions may increase the risk to UTI development, among them vesicoureteral reflux (VUR) is considered the most common urologic abnormality diagnosed in childhood and is directly connected to the risk of development of pyelonephritis during the UTI episodes.
Objectives: To compare the epidemiologic, microbiologic and imaging characteristics of UTI in children < 2 years of age with and without anatomic urinary tract abnormalities (AA).
Methods: All children hospitalized with UTI during 1.1.2005-31.12.2018 were included. The study group (patients with AA) included 76 patients. The control group (99 patients) included patients without AA.
Results: 1.163 children with UTI were hospitalized. Age at diagnosis was younger in the study group vs. controls (5.2 ± 6.0 vs. 7.9 ± 7.5 months, P = 0.038). Uropathogens distribution was different (P = 0.007), with lower Escherichia coli (Ec) and Proteus mirabilis (Pm) percentages in study group and higher percentages of Enterococcus spp. (Ent) in controls. In the study group, Ec nonsusceptibility rates to ampicillin, amoxicillin/clavulanic acid, cefazolin, cefuroxime, TMP/SMX and ceftriaxone were 58%, 40%, 14%, 14%, 12% and 10%, respectively, with no differences vs. controls. Ultrasound (US) was performed in 69/76 (98%) patients with AA and was abnormal in 84.1%; bilateral (39.7%) and unilateral (32.7%) ureteral dilatation were the most frequent findings. Voiding cystourethrography was performed in 46 patients (pathologic in 35, 76%); 31 (81.6%) patients had VUR (bilateral in 11, 35.5%; grade 4/5 in 7 patients). Uropathogens distribution in patients with VUR was different between study and control groups, with lower Ec and Pm in the first group and higher Pseudomonas aeruginosa and Ent percentages in the control group.
Conclusion: Age at diagnosis was lower and pathogen distribution was different in patients with AA compared with patients without AA. Antibiotic susceptibility patterns of the main uropathogens were similar between patients with or without AA.
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