title: Comparison of acute lobar nephronia and uncomplicated urinary tract infection in children.
abstract: OBJECTIVE
  This aim of this study was to assess the clinical manifestations, the microorganisms involved and their antibiotic resistance in children hospitalized due to acute lobar nephronia (ALN) and non-ALN community-acquired urinary tract infections (UTIs).
  
  
  METHODS
  We retrospectively reviewed the records of 265 previously healthy children hospitalized due to a first-episode of community-acquired febrile UTI between July 2004 and June 2007. Based on the results of renal ultrasonography and computed tomography, they were divided into ALN and non-ALN groups. Their demographic and clinical characteristics, distribution of microorganisms, and their antimicrobial resistance were analyzed.
  
  
  RESULTS
  Of the total number of cases of children admitted with a first-episode community-acquired UTI, 19.2% (n=51) were diagnosed as ALN. Children with ALN were older (1.86 years vs. 0.81 years; p < 0.01), had longer periods of fever before admission (4.7 days vs. 1.4 days; p < 0.01), higher peak body temperatures (39.5°C vs. 38.9°C; p < 0.01), higher white cell counts (18.86 × 10(9)/L vs. 15.08 × 10(9)/L; p < 0.01) and higher C-reactive protein levels (9.0 mg/dL vs. 3.5 mg/dL; p < 0.01) compared with non-ALN children. Fever also persisted for longer after the start of antibiotic treatment in the ALN children (2.7 days vs. 1.4 days: p < 0.01) and they required longer hospital stays and incurred higher medical costs. The major pathogen found in ALN was E. coli (90%). The E. coli isolated from ALN children was more resistant to cotrimoxazole and ciprofloxacin than those from non-ALN children.
  
  
  CONCLUSIONS
  ALN is not uncommon in children with a first-episode febrile UTI. They have a prolonged clinical course, higher inflammatory parameters, longer hospital stays and incur higher medical costs. E. coli is the major pathogen isolated from these children.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Yang
authors.forename: Pei-Lan
authors.initials: PL
authors.lastname: Shao
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Lu
authors.forename: Yong-Kwei
authors.initials: YK
authors.lastname: Tsau
authors.forename: I-Jung
authors.initials: IJ
authors.lastname: Tsai
authors.forename: Ping-Ing
authors.initials: PI
authors.lastname: Lee
authors.forename: Luan-Yin
authors.initials: LY
authors.lastname: Chang
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000382:microbiology; D003937:Diagnosis, Differential; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007958:Leukocyte Count; D008297:Male; D008826:Microbial Sensitivity Tests; D009393:Nephritis / Q000175:diagnosis* / Q000382:microbiology*; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein