Abstract
Background
Because urinary tract infection (UTI) is the most frequent source of serious bacterial
infections in young children, we studied the bacteriology of such infections in our
institution.
Objectives
Pediatric urine cultures were reviewed for age- and sex-specific differences in testing,
prevalence, causative organisms, and antibiotic sensitivities.
Methods
A retrospective 5-year observational study of all urine cultures from Emergency Department
patients aged 0–36 months found 4403 cultures. Primary outcomes were numbers of cultures
obtained, infections found, the organisms isolated, and their antibiotic sensitivities.
Results
Boys were cultured much less frequently (overall 4.7% vs. 19.4% of girls, p < 0.001). Three hundred ninety-six cultures yielded infection episodes. Although
far fewer boys were cultured, their overall positive culture rate (10.9%) was significantly
higher than for girls (8.4%; p = 0.01), with more Gram-positive organisms (52.3%; vs. 18.6% Gram-positives in girls;
p < 0.001). The rate of positive cultures in boys and girls remained 8.4% and 10.3%,
respectively, even in 2-year-olds. Trimethoprim-sulfamethoxazole and amoxicillin/clavulanic
acid were effective against all isolates.
Conclusions
Age- and sex-based assumptions guiding evaluation for and treatment of UTIs in young
children should be reevaluated. We may not be culturing enough young boys, risking
missed UTIs with potential for renal injury in this vulnerable group. Based on their
significant rate of Gram-positive infections, those boys we treat empirically might
benefit more from trimethoprim/sulfamethoxazole or amoxicillin/clavulanic acid than
from third-generation cephalosporins. The persistence of positive cultures in 2-year-olds
suggests we should be culturing beyond 24 months in both sexes. Urine Gram stains
should be more frequently considered.
Keywords
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Article info
Publication history
Published online: December 22, 2014
Accepted:
November 16,
2014
Received in revised form:
October 10,
2014
Received:
April 14,
2014
Footnotes
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Copyright constraints: I am an employee of the U.S. Government. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person's official duties.
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