title: Community-acquired enterococcal urinary tract infections in hospitalized children.
abstract: The objectives of this study were to characterize community-acquired (CA) enterococcal urinary tract infections (UTIs) in a tertiary pediatric center and to determine risk factors for their occurrence, their association with renal abnormalities, their antibiotic susceptibility profile, and the appropriateness of the empiric antibiotic treatment, in comparison to those of Gram-negative UTIs. In a 5-year prospective clinical and laboratory study, we found that enterococcal UTIs caused 6.2% (22/355) of culture-proven CA UTIs. Compared with Gram-negative UTI, enterococcal UTI was associated with male predominance, higher rates of underlying urinary abnormalities (70 vs. 43.7%; p = 0.03) and inappropriate empiric antibiotic therapy (22 vs. 5.6%; p = 0.02), and mainly vesicoureteral reflux (53% of cases). This study highlights the importance of early detection of CA enterococcal UTIs because of their association with underlying urinary abnormalities and a high rate of inappropriate empiric antibiotic therapy. Renal imaging is recommended for children with enterococcal UTIs; Gram stain is suggested in selected cases to detect Gram-positive cocci for early diagnosis of enterococcal UTIs and initiation of appropriate antibiotics.
authors.affiliation: Department of Pediatrics A, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Marcus
authors.forename: Shai
authors.initials: S
authors.lastname: Ashkenazi
authors.forename: Zmira
authors.initials: Z
authors.lastname: Samra
authors.forename: Avner
authors.initials: A
authors.lastname: Cohen
authors.forename: Gilat
authors.initials: G
authors.lastname: Livni
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D016009:Chi-Square Distribution; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D042241:Early Diagnosis; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents