ESPN 53rd Annual Meeting

ESPN 2021


 
Is a Different Follow-up Procedure Necessary For Infants with First Febrile Urinary Tract Infection Caused by Non-E.coli and/or Extended-spectrum B-Lactamase-Producing Bacteria?
MUSTAFA KAVRUK 1 EREN SOYALTIN 2 GÖKÇEN ERFIDAN 2 SEÇIL ARSLANSOYU ÇAMLAR 3 DEMET ALAYGUT 2 FATMA MUTLUBAŞ 3 NISEL YILMAZ 4 BELDE KASAP DEMIR 5

1- UNIVERSITY OF HEALTH SCIENCES, TEPECIK TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRICS, IZMIR, TURKEY
2- UNIVERSITY OF HEALTH SCIENCES, TEPECIK TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRICS, DIVISION OF NEPHROLOGY, IZMIR, TURKEY
3- UNIVERSITY OF HEALTH SCIENCES, IZMIR FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRICS, DIVISION OF NEPHROLOGY, IZMIR, TURKEY
4- UNIVERSITY OF HEALTH SCIENCES, TEPECIK TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF CLINICAL MICROBIOLOGY, IZMIR, TURKEY
5- İZMIR KATIP CELEBI UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRICS, DIVISION OF NEPHROLOGY AND RHEUMATOLOGY, IZMIR, TURKEY
 
Introduction:

We aimed to evaluate the effects of non-E.coli or extended-spectrum beta-lactamase-producing bacterial (ESBL-PB) growth in the first febrile UTI of infants

Material and methods:

The data of patients aged between 2-24 months and were followed up for at least 6 were retrospectively analyzed. Ultrasonography was performed in all cases at the time of the infection and dimercaptosuccinic acid (DMSA) at least 4 months after the infection. Voiding cystourethrography (VCUG) was performed only if ultrasonography findings were suggestive of vesicoureteral reflux (VUR), the up-take deformity was detected in DMSA scan or the patients experienced recurrent UTIs. The patients were grouped concerning E.coli or non-E.coli and ESBL-PB or non-ESBL-BP growth in urine cultures.

Results:

There were 277 (M/F:153/124) infants followed up for 28.55±15.24 (6-86) months. The causative microorganisms were non-E.coli in 73 (26.4%); and ESBL-PB in 58 (20.9%) cases. CRP values, pyuria, and leukocyte esterase positivity were significantly higher in UTIs caused by E.coli compared to non-E.coli bacteria (p=0.027, p<0.001 and p<0.001, respectively). All clinical and laboratory findings were similar between the ESBL-PB and non-ESBL groups, but abnormal ultrasonography findings were more common in the non-E.coli group (p=0.029). The white blood cell count was significantly higher in patients with VUR compared to those without VUR (p=0.012). Multivariate analysis revealed that leukocyte esterase positivity (p=0.024) and high-grade VUR (p= 0.004) were independent risk factors for renal damage in DMSA scan.

Conclusions:

Prioritizing the date of further radiological examinations would not be mandatory, just because the patients are infected with non-E.coli or ESBL-PB, as long as all they undergo urinary USG after the first febrile UTI.