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Urinary tract infections in children < 2 years of age hospitalized in a tertiary medical center in Southern Israel: epidemiologic, imaging, and microbiologic characteristics of first episode in life

  • David Shaki
  • Gabriel Hodik
  • Siham Elamour
  • Raouf Nassar
  • Eyal Kristal
  • Ron Leibovitz
  • Amir Horev
  • Eugene LeibovitzEmail author
Original Article

Abstract

The objectives of the study were to describe the epidemiologic, microbiologic, and imaging characteristics of first 44 UTI episode in hospitalized infants and children < 2 years of age. A UTI episode was diagnosed based on suprapubic aspiration or urinary catheterization and report of a significant bacterial growth of true uropathogens. Two thousand two hundred ninety-four UTI episodes were recorded during 2009–2013 in 1694 patients; 1350 (79.7%), 223 (13.2%), and 66 (3.9%) had one, two, and three episodes, respectively. Of 1955 pathogens isolated, the most frequent were E. coli, Klebsiella spp., and Enterococcus spp. (56.9%, 14.1%, and 11%, respectively). E. coli percentages increased with increase in patient age while Klebsiella spp. and Enterococcus spp. decreased with decrease in age. 136/344 (39.5%) renal ultrasound examinations performed were reported abnormal. The percentages of abnormal ultrasound examinations in Enterococcus spp.-UTI were higher than in E. coli and Klebsiella spp.-UTI (P < 0.001 and P = 0.007, respectively). The E. coli nonsusceptibility to ampicillin, TMP/SMX, ceftriaxone, amoxicillin/clavulanic acid, cefuroxime, and gentamicin was 71%, 31%, 14.9%, 14.7%, 7%, and 4.4%, respectively. Nonsusceptibility of Klebsiella spp. to ampicillin, amoxicillin/clavulanic acid, TMP/SMX, ceftriaxone, gentamicin, and cefuroxime was 98.7%, 10.4%, 9.5%, 8.4%, 4.8%, and 4.3%, respectively. E. coli nonsusceptibility to amoxicillin/clavulanate, TMP/SMX, and ciprofloxacin decreased during the study period. E. coli percentages increased and those of Klebsiella spp. and Enterococcus spp. decreased with increase in patient age. Enterococcus. spp.-UTI was associated with older age and more severe findings on renal ultrasound. E. coli and Klebsiella spp. nonsusceptibility to amoxicillin/clavulanate, TMP/SMX, cefuroxime, and ceftriaxone was low.

Keywords

Urinary tract infection Infants Escherichia coli Ultrasound Antibiotics 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The research protocol was approved by the Ethics Committee of the Soroka University Medical Center.

Informed consent

Retrospective research, informed consent not needed.

References

  1. 1.
    Roberts KB (2004) Urinary tract infection treatment and evaluation. Update. Pediatr Infect Dis J 23:1163–1164PubMedGoogle Scholar
  2. 2.
    Shaikh N, Morone NE, Bost JE, Farrell MH (2008) Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 27:302–308CrossRefGoogle Scholar
  3. 3.
    American Academy of Pediatrics (2011) Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Pediatrics 128:595–610CrossRefGoogle Scholar
  4. 4.
    Finnel SME, Carroll AE, Downs SM (2011) Technical report-diagnosis and management of an initial UTI in febrile infants and young children. American Academy of Pediatrics. Pediatrics 128:e749–e770CrossRefGoogle Scholar
  5. 5.
    Schlager TA (2004) Urinary tract infections in infants and children: a comprehensive overview. Curr Opin Pediatr 16:85–88CrossRefGoogle Scholar
  6. 6.
    Cataldi L, Zaffanello M, Gnarra M, Fanos V (2010) Urinary tract infection in the newborn and the infant: state of the art. J Mater Fetal Neonatal Med 23:90–93CrossRefGoogle Scholar
  7. 7.
    Ismaili K, Wissing KM, Lolin K, Le PQ, Cristophe C, Lepage P et al (2011) Characteristics of first urinary tract infection with fever in children—a prospective clinical and imaging study. Pediatr Infect Dis J 30:371–374CrossRefGoogle Scholar
  8. 8.
    Ismaili K, Lolin K, Damry N, Alexander M, Lepage P, Hall M (2011) Febrile urinary tract infection in 0-to-3-month-old infants: a prospective follow-up study. J Pediatr 58:91–94CrossRefGoogle Scholar
  9. 9.
    American Academy of Pediatrics (2016) Subcommittee on urinary tract infection. Reaffirmation of AAP clinical practice guideline: the diagnosis and management of the initial urinary tract infection in febrile and children 2–24 months of age. Pediatrics 138:e20163026CrossRefGoogle Scholar
  10. 10.
    Jones RN, Kugler KC, Pfaller MA, Winokur PL (1999) Characteristics of pathogens causing urinary tract infections in hospitals in North America: results from the SENTRY Antimicrobial Surveillance Program. Diagn Microbiol Infect Dis 35:55–63CrossRefGoogle Scholar
  11. 11.
    Gupta K (2002) Addressing antibiotic resistance. Am J Med 113(Suppl 1A):29S–34SCrossRefGoogle Scholar
  12. 12.
    Farrell DJ, Morrissey I, De Rubeis D, Robbins M, Felmingham D (2003) A UK multicentre study of the antimicrobial susceptibility of bacterial pathogens causing urinary tract infection. J Inf Secur 46:94–100Google Scholar
  13. 13.
    Yüksel S, Oztürk B, Kavaz A, Ozçakar ZB, Acar B, Güriz H et al (2006) Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in Turkish children with urinary tract infections. Int J Antimicrob Agents 28:413–416CrossRefGoogle Scholar
  14. 14.
    Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C (2016) Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. BMJ 352:1939.  https://doi.org/10.1136/bmj/1939 CrossRefGoogle Scholar
  15. 15.
    Ashkenazi S, Even-Tov S, Samra Z, Dinari G (1991) Uropathogens of various childhood populations and their antibiotic susceptibility. Pediatr Infect Dis J 10:742–746CrossRefGoogle Scholar
  16. 16.
    Marcus N, Ashkenazi S, Yaari A, Samra Z, Livni G (2005) Non-Escherichia coli versus Escherichia coli community-acquired urinary tract infections in children hospitalized in a tertiary center: relative frequency, risk factors, antimicrobial resistance and outcome. Pediatr Infect Dis J 24:581–585CrossRefGoogle Scholar
  17. 17.
    Gurevich E, Tchernin D, Schreyber R, Muller R, Leibovitz E (2015) Follow-up after infants younger than 2 months of age with urinary tract infection in Southern Israel: epidemiologic, microbiologic and disease recurrence characteristics. Braz J Infect Dis.  https://doi.org/10.1016/j.bjid2015.09.003
  18. 18.
    Alberici I, Bayazit AK, Drozdz D, Emre S, Fischbach M, Harambat J et al (2015) Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group. Eur J Pediatr 174:783–790CrossRefGoogle Scholar
  19. 19.
    Marcus N, Ashkenazi S, Samra Z, Cohen A, Livni G (2012) Community-acquired enterococcal urinary tract infections in hospitalized children. Pediatr Nephrol 27:109–114CrossRefGoogle Scholar
  20. 20.
    Giorgi LJ, Bratislavsky G, Kogan BA (2005) Febrile urinary tract infections in infants: renal ultrasound remains necessary. J Urol 173:568–570CrossRefGoogle Scholar
  21. 21.
    Jahnukainen T, Honkinen O, Ruuskanen O, Mertsola J (2006) Ultrasonography after the first febrile urinary tract infection in children. Eur J Pediatr 165:556–559CrossRefGoogle Scholar
  22. 22.
    Lopez Sastre JB, Ramos Aparicio A, Coto Cotallo GD, Fernandez Colomer B, Crespo Hernandez M (2007) Urinary tract infection in the newborn: clinical and ration imaging studies. Pediatr Nephrol 22:1735–1741CrossRefGoogle Scholar
  23. 23.
    Montini G, Zuchetta P, Tomasi L, Talenti E, Rigamonti W, Picco G et al (2009) Value of imaging studies after a first febrile urinary tract infection in young children: data from Italian renal infection study 1. Pediatrics 1213:e239–e246CrossRefGoogle Scholar
  24. 24.
    Nowell L, Moran C, Smith PB, Seed P, Alexander BD, Cotton M et al (2010) Prevalence of renal anomalies following urinary tract infections in hospitalized infant less than two months of age. J Perinatol 30:281–285CrossRefGoogle Scholar
  25. 25.
    Lascola C, De Mutils C, Hewitt IK, Puccio G, Toffolo A, Zuccheta P et al (2013) Different guidelines for imaging after first UTI in febrile infants: yield, cost and radiation. Pediatrics 131:e665–e671CrossRefGoogle Scholar
  26. 26.
    Juliano TM, Stephany HA, Clayton DB, Thomas JC, Pope JC 4th, Adams MC et al (2013) Incidence of abnormal imaging and recurrent pyelonephritis after first febrile urinary tract infection in children 2 to 24 months old. J Urol 190:1505–1510.  https://doi.org/10.1016/j.juro.2013.01.049 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • David Shaki
    • 1
    • 2
  • Gabriel Hodik
    • 3
  • Siham Elamour
    • 1
    • 2
  • Raouf Nassar
    • 1
  • Eyal Kristal
    • 1
  • Ron Leibovitz
    • 1
  • Amir Horev
    • 1
  • Eugene Leibovitz
    • 1
    • 2
    Email author
  1. 1.Division of PediatricsSoroka University Medical Center, Ben-Gurion UniversityBeer ShevaIsrael
  2. 2.Pediatric Infectious Disease UnitSoroka University Medical Center, Ben-Gurion UniversityBeer ShevaIsrael
  3. 3.Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael

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