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Factors Associated With Bacteremia in Young Infants With Urinary Tract Infection

Averbuch, Diana MD*†; Nir-Paz, Ran MD; Tenenbaum, Ariel MD§; Stepensky, Polina MD*; Brooks, Rebecca MD§; Koplewitz, Benjamin Z. MD; Simckes, Ari M. MD*‖; Engelhard, Dan MD*†**

The Pediatric Infectious Disease Journal: June 2014 - Volume 33 - Issue 6 - p 571–575
doi: 10.1097/INF.0000000000000316
Original Studies

Background: Urinary tract infection (UTI) is the most frequent severe bacterial infection in infants. Up to 31% of infants with UTI have bacteremia.

Methods: We retrospectively identified all infants aged 0–2 months who were managed in our hospital with UTI during a 1-year period. Those with bacteremia were compared with those without bacteremia, according to the following variables: ethnicity, age, gender, white blood cell and polymorphonuclear counts, C-reactive protein, urinalysis and blood creatinine values as related to age-appropriate norms, imaging and outcome.

Results: We identified 81 infants with 82 episodes of UTI. Most occurred in males (72.8%) and 35 (42.7%) were in infants of non-Jewish origin. In 14/81 (17.3%) of episodes, Escherichia coli was cultured from blood. In multivariate analysis, increased blood creatinine levels (P = 0.004) and non-Jewish origin (P = 0.006) were associated with bacteremia. Time to defervescence was significantly longer in bacteremic versus nonbacteremic children (P = 0.018). Duration of hospitalization was longer in bacteremic infants—10 (7–17) days in bacteremic versus 7 (1–14) days in nonbacteremic children (P < 0.001).

Conclusions: In infants aged 0–2 months with UTI, increased blood creatinine value at admission was associated with bacteremia. This value provides an additional clue on admission, independent of personal judgment, to help identify infants at higher risk for bacteremia, prolonged hospitalization and possible complications.

From the *Department of Pediatrics, Ein Kerem, Pediatric Infectious Diseases Unit, Department of Clinical Microbiology and Infectious Diseases, §Department of Pediatrics, Mount Scopus, Department of Medical Imaging, and Pediatric Nephrology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and **School of Primary Health Care, Monash University, Melbourne, Victoria, Australia.

Accepted for publication November 14, 2013.

This study was presented at the ICAAC Conference, 2008.

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

Address for correspondence: Diana Averbuch, MD, Pediatric Infectious Diseases Unit, Hadassah-Hebrew University Medical Center, Ein Kerem, Kiryat Hadassah, P.O.B. 12000, Jerusalem, 91120, Israel. E-mail:,

© 2014 by Lippincott Williams & Wilkins, Inc.