title: Community-acquired enterococcal urinary tract infections.
abstract: Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered break-through infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery compared with the total cohort of children with Gram-negative UTIs. However children with enterococcal UTIs did not present with a worse prognosis when compared with a group of children with Gram-negative UTIs matched for age and degree of reflux. Enterococcal infection is not an independent risk factor for poor outcome, nevertheless positive urine culture including enterococci is highly indicative for underlying urinary tract abnormalities, recurrences, renal scarring, and need for surgical intervention.
authors.affiliation: Department of Pediatrics, Infectious Diseases Unit, University Hospital of Heraklion, University of Crete, POB 2208, 71003 Heraklion, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Bitsori
authors.forename: Sofia
authors.initials: S
authors.lastname: Maraki
authors.forename: Maria
authors.initials: M
authors.lastname: Raissaki
authors.forename: Anna
authors.initials: A
authors.lastname: Bakantaki
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Galanakis
mesh_terms: D002675:Child, Preschool; D017714:Community-Acquired Infections; D013293:Enterococcus faecalis; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D014551:Urinary Tract / Q000002:abnormalities; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy