Prevalence of Enterococcal UTI in High Risk Patients with Positive Nitrites in Dipstick Urinalysis

Introduction: Enterococcus is a relatively uncommon pathogen causing urinary tract infections (UTIs) in healthy children. Most Enterococcal infections occur in patients who have risk factors such as anatomical or functional urinary tract anomalies. Many children suspected to have urinary tract infection and have some of the risk factors are treated specifically for enterococcal infection as part of their empiric regimen. Our primary objective was to determine the prevalence of enterococcal UTIs among high risk children, and among those with positive nitrite tests in order to consider avoiding treatment with specific anti-enterococcal agents in those cases

Methods: Retrospective study was conducted at a tertiary paediatric centre between 2010 and 2018 and included all hospitalized UTI episodes. Data from medical record was collected, including nephrological and urological risk factors, nitrites status, and isolated pathogen.

Results: out of 1182 cases of UTI , 558 (47.2%) cases were considered high risk patients. 39 from all cases of UTI in the high-risk group, had enterococcus as a single pathogen, 38 (97.4%) of them occurred in patients with negative nitrites in the first urine dipstick taken. 1 patient in the entire study cohort (0.004% from the high risk group), had positive nitrites and coexisting enterococcal UTI. This patient had history of previous enterococcal UTIs.,

Conclusion: in pediatric patients with nephrological and urological risk factors, that has positive nitrites in urinalysis, the risk for Enterococcal UTI is substantially low. Therefore, specific anti-enterococcal empirical antibiotic therapy may be unnecessary.