Antimicrobial Resistance and Diagnostic Imaging in Infants Younger Than 2 Months Old Hospitalized With a First Febrile Urinary Tract Infection: A Population-based Comparative Study.
BACKGROUND
Data on urinary tract infection (UTI) in infants ≤2 months of age are limited. We examined clinical characteristics, antimicrobial resistance, imaging findings and clinical outcomes in infants ≤2 months of age and children 2-24 months of age hospitalized with the first febrile UTI.


METHODS
Children ≤24 months of age hospitalized with their first-diagnosed febrile UTI were prospectively studied. Renal ultrasonography, Tc-dimercaptosuccinic acid scanning and voiding cystourethrography were performed in all children.


RESULTS
Of the 388 children analyzed (255 boys and 133 girls), 61 patients were ≤2 months of age, representing 15.7% of the whole population, whereas 327 patients were 2-24 months of age. Escherichia coli was the predominant bacterium, with similar antimicrobial resistance in the 2 groups, and associated E. coli bacteremia occurred in 9 patients (2.3%). Renal ultrasonography showed abnormal findings in 130 patients (33.5%), but there was no difference in the rate of abnormal findings between the groups. Vesicoureteral reflux (VUR) was present in 130 children (33.5%), including 93 (24%) with grades III-V VUR. VUR was more prevalent in the infants ≤2 months of age (P = 0.007), but there was no difference in the prevalence of grades III-V VUR between the groups. The incidence of renal scarring was 28.6% (111/388), and it did not differ between the groups.


CONCLUSIONS
There are similarities in clinical characteristics, antimicrobial resistance, imaging findings and clinical outcomes after a first UTI between the young infants ≤2 months and children 2-24 months of age. The same guidelines for the diagnosis and management after the first febrile UTI can be applied to children who are ≤24 months of age.
From the *Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan; †School of Medicine and ‡Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; §Department of Pediatrics, ¶Department of Internal Medicine, and ‖Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan.
Chih-Chuan
CC
Hsu
Jeng-Dau
JD
Tsai
Min-Sho
MS
Ku
Shan-Ming
SM
Chen
Pei-Fen
PF
Liao
Tung-Wei
TW
Hung
Min-Ling
ML
Tsai
Ji-Nan
JN
Sheu
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects; D024881:Drug Resistance, Bacterial; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D016896:Treatment Outcome; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology*; D014718:Vesico-Ureteral Reflux
D000900:Anti-Bacterial Agents