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Volume 43, Number 3, June 2010

Comparison of Acute Lobar Nephronia and Uncomplicated Urinary Tract Infection in Children


Ching-Chi Yang, Pei-Lan Shao, Chun-Yi Lu, Yong-Kwei Tsau, I-Jung Tsai, Ping-Ing Lee, Luan-Yin Chang, Li-Ming Huang


Received: March 30, 2009    Revised: April 30, 2009    Accepted: July 16, 2009   

 

Corresponding author:

 Luan-Yin Chang

 

Division of Pediatric Infectious

Disease, Department of Pediatrics, National Taiwan

University Hospital, 7 Chung-Shan South Road, Taipei

10002, Taiwan.

E-mail: ly7077@tpts6.seed.net.tw

 



 

Background and purpose: 

This aim of this study was to assess the clinical manifestations, the microorganisms involved and their antibiotic resistance in children hospitalized due to acute lobar nephronia (ALN) and non-ALN community-acquired urinary tract infections (UTIs).



 

Methods:

We retrospectively reviewed the records of 265 previously healthy children hospitalized due to a first-episode of community-acquired febrile UTI between July 2004 and June 2007. Based on the results of renal ultrasonography and computed tomography, they were divided into ALN and non-ALN groups. Their demographic and clinical characteristics, distribution of microorganisms, and their antimicrobial resistance were analyzed.



 

Results:

Of the total number of cases of children admitted with a first-episode community-acquired UTI, 19.2% (n=51) were diagnosed as ALN. Children with ALN were older (1.86 years vs. 0.81 years; p < 0.01), had longer periods of fever before admission (4.7 days vs. 1.4 days; p < 0.01), higher peak body temperatures (39.5°C vs. 38.9°C; p < 0.01), higher white cell counts (18.86 × 109/L vs. 15.08 × 109/L; p < 0.01) and higher C-reactive protein levels (9.0 mg/dL vs. 3.5 mg/dL; p < 0.01) compared with non-ALN children. Fever also persisted for longer after the start of antibiotic treatment in the ALN children (2.7 days vs. 1.4 days: p < 0.01) and they required longer hospital stays and incurred higher medical costs. The major pathogen found in ALN was E. coli (90%). The E. coli isolated from ALN children was more resistant to cotrimoxazole and ciprofloxacin than those from non-ALN children.



 

Conclusion:

ALN is not uncommon in children with a first-episode febrile UTI. They have a prolonged clinical course, higher inflammatory parameters, longer hospital stays and incur higher medical costs. E. coli is the major pathogen isolated from these children.



 

Key words:

acute lobar nephronia antibiotic resistance children community acquired urinary tract infection