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Antimicrobial Resistance and Diagnostic Imaging in Infants Younger Than 2 Months Old Hospitalized With a First Febrile Urinary Tract Infection: A Population-based Comparative Study

Hsu, Chih-Chuan MD; Tsai, Jeng-Dau MD, PhD; Ku, Min-Sho MD, PhD; Chen, Shan-Ming MD, PhD; Liao, Pei-Fen MD; Hung, Tung-Wei MD; Tsai, Min-Ling MMS; Sheu, Ji-Nan MD, PhD

The Pediatric Infectious Disease Journal: August 2016 - Volume 35 - Issue 8 - p 840–845
doi: 10.1097/INF.0000000000001184
Original Studies

Background: Data on urinary tract infection (UTI) in infants ≤2 months of age are limited. We examined clinical characteristics, antimicrobial resistance, imaging findings and clinical outcomes in infants ≤2 months of age and children 2–24 months of age hospitalized with the first febrile UTI.

Methods: Children ≤24 months of age hospitalized with their first-diagnosed febrile UTI were prospectively studied. Renal ultrasonography, 99mTc-dimercaptosuccinic acid scanning and voiding cystourethrography were performed in all children.

Results: Of the 388 children analyzed (255 boys and 133 girls), 61 patients were ≤2 months of age, representing 15.7% of the whole population, whereas 327 patients were 2–24 months of age. Escherichia coli was the predominant bacterium, with similar antimicrobial resistance in the 2 groups, and associated E. coli bacteremia occurred in 9 patients (2.3%). Renal ultrasonography showed abnormal findings in 130 patients (33.5%), but there was no difference in the rate of abnormal findings between the groups. Vesicoureteral reflux (VUR) was present in 130 children (33.5%), including 93 (24%) with grades III–V VUR. VUR was more prevalent in the infants ≤2 months of age (P = 0.007), but there was no difference in the prevalence of grades III–V VUR between the groups. The incidence of renal scarring was 28.6% (111/388), and it did not differ between the groups.

Conclusions: There are similarities in clinical characteristics, antimicrobial resistance, imaging findings and clinical outcomes after a first UTI between the young infants ≤2 months and children 2–24 months of age. The same guidelines for the diagnosis and management after the first febrile UTI can be applied to children who are ≤24 months of age.

From the *Department of Pediatrics, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan; School of Medicine and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; §Department of Pediatrics, Department of Internal Medicine, and Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan.

Accepted for publication January 22, 2016.

Supported by grants from the Chung Shan Medical University Hospital, Taichung, Taiwan (CSH-2011-C-015, CSH-2012-C-010 and CSH-2013-C-011) and National Science Council, Taipei, Taiwan (NSC93-2314-B-040-012).

The authors have no other funding or conflicts of interest to disclose.

C.-C.H. and J.-D.T. contributed equally to this study.

Address for correspondence: Ji-Nan Sheu, MD, PhD, Department of Pediatrics, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo North Road, Taichung 402, Taiwan. E-mail: cshy098@csh.org.tw.

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