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Urinary Tract Infections in Febrile Infants under Three Months of Age

Journal of the Korean Pediatric Society 2003;46(3):265-270.
Published online March 15, 2003.
Urinary Tract Infections in Febrile Infants under Three Months of Age
Byung Wook Eun, Yoo Mi Chung, Hee Gyung Kang, Il Soo Ha, Hae Il Cheong, Hoan Jong Lee, Yong Choi
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
3개월 이하 영아기 열성 요로감염증에 대한 임상적 관찰
은병욱, 정유미, 강희경, 하일수, 정해일, 이환종, 최용
서울대학교 의과대학 소아과학교실
Yong Choi, Email: ychoi@plaza.snu.ac.kr
: To characterize the infants under 3 months of age with urinary tract infections(UTIs), and especially patients with bacteremia or meningitis
: Hospital records of all the infants under 3 months of age discharged from our hospital for 69 consecutive months with the diagnosis of initial episode of UTI were reviewed. UTI was defined when patients had fever with pyuria, and had urine culture results of ≥105 colony forming units/mL from a bag specimen. Patients with previously known urologic abnormality or immunodeficiency were excluded. Nosocomial infections were also excluded from the study.
: The male:female ratio was 35 : 6. Of the urine cultures, 40(97.6%) yielded single pathogen, one yielded two pathogens. Escherichia coli was the predominant isolate from the urine. Five patients(12%) also had bacteremia. Pathogens isolated from the blood cultures were E. coli(4) and Enterococcus faecalis(1). No patient had culture-positive meningitis or cerebrospinal fluid pleocytosis. Clinical or laboratory findings between patients with and without bacteremia were not different significantly. The rate of vesicoureteral reflux(VUR) was 44%. The sensitivity of ultrasound for detection of VUR was 38%; specificity was 50%.
: Clinical and laboratory data were not helpful for identifying patients with bacteremia at the time of presentation. Consequently, blood cultures need to be obtained from all febrile infants under 3 months of age with UTIs. A large-scale study including the indication of lumbar puncture for infants with a febrile UTI and study of evaluation and treatment of infants under 3 months of age with UTIs are required.
Key Words: Urinary tract infections, Febrile infants, Bacteremia, Meningitis

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