title: Low bacterial count urinary tract infections in infants and young children.
abstract: The purpose of the study was to compare bacterial species, clinical, laboratory and imaging findings ((99m )Tc-dimercaptosuccinic acid renal scan and voiding cystogram) in infants and children with high (>/=10(5) colony forming units (CFU)/ml, group A patients) and low (</=5 x 10(4) CFU/ml, group C patients) bacterial count in urine cultures during first episode of urinary tract infection. Group B included patients with intermediate CFU/ml. Included were 419 symptomatic patients with: (a) no previous antibiotic treatment, (b) urine samples for quantitative cultures taken by bladder catheterisation or suprapubic bladder aspiration, (c) growth of only one microorganism, and (d) age </=54 months (age of the oldest patient of group C). Out of 419 cultures, Escherichia coli grew in 315 (75.2%), gram-negative bacteria except E. coli in 91 (21.7%) and gram-positive in 13 (3.1%). Group C patients were significantly ( P <0.0001) more often affected with gram-negative pathogens except E. coli than group A patients (21/44 versus 67/360). Most of group C patients were younger than 24 months of age; none was older than 54 months. Comparison of the prevalence of clinical and laboratory (leucocyte count, CRP, ESR) findings between groups A and C showed no significant differences. There was no statistically significant difference in the prevalence of pyelonephritis, reflux and urological malformations (except reflux) between groups A and C.
  
  
  CONCLUSIONS
  Low bacterial count urinary tract infections mainly affect infants and young children and are often due to gram-negative bacteria other than E. coli. Clinical and laboratory findings, prevalence of pyelonephritis, reflux and urological malformations are similar in high and low bacterial count urinary tract infections.
authors.affiliation: Department of Paediatrics, School of Medicine, University of Patras, 265 04, Patras, Greece. dimapapa@med.upatras.gr
authors.forename: Theodoros A
authors.initials: TA
authors.lastname: Kanellopoulos
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Vassilakos
authors.forename: Marinos
authors.initials: M
authors.lastname: Kantzis
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Ellina
authors.forename: Fevronia
authors.initials: F
authors.lastname: Kolonitsiou
authors.forename: Dimitris A
authors.initials: DA
authors.lastname: Papanastasiou
mesh_terms: D001437:Bacteriuria / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D002675:Child, Preschool; D015169:Colony Count, Microbial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D011704:Pyelonephritis / Q000453:epidemiology*; D014551:Urinary Tract / Q000002:abnormalities*; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology*
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