Background: The ability to predict bacteremia can help to identify the more severely ill infants with urinary tract infection (UTI). Resistance to antibiotics is reported.
Methods: Healthy infants with UTI, up to 2 months of age, were studied retrospectively. Clinical and laboratory data at presentation of bacteremic infants were compared to nonbacteremic infants. Antimicrobial susceptibility was analyzed.
Results: 343 episodes of UTI with 366 pathogens, 239 in males, 107 in infants of Arab origin were studied. 29 (9%) developed bacteremia, E.coli was the only pathogen. A multivariable logistic regression model revealed five statistically significant parameters for prediction of bacteremia: younger age, Arab origin, abnormal polymorphonuclears count, creatinine >95th percentile and abnormal urinalysis (positive nitrites or leukocytes). A scoring system based on this model enables prediction of occurrence or absence of bacteremia in each infant, with sensitivity and specificity of 77.7% and 81.5%, respectively. Gram-negative isolates (n=314) were susceptible to the following antibiotics: ampicillin 81/314 (25.8%), ampicillin/clavulonate 241/308 (78.2%), cefazolin 241/308 (78.2%), cefuroxime 284/312 (90.4%), ceftriaxone 288/310 (92.9%), gentamicin 292/314 (93.0%); 291/314 (92.7%) were susceptible to the empirical protocol administered. Duration of hospitalization was longer in infants with bacteremia (mean 10.7 vs. 5.7 days, p<0.001); and in infants in whom isolated bacteria were resistant to the empirical therapy (8.25 vs. 6.53 days, p=0.012).
Conclusion: Scoring system based on five objective parameters provides an additional clue on admission, independent of personal judgment, to help identify infants at higher risk for bacteremia and possible complications. Resistance to antibiotics is emerging.
