Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria

Abstract Gram-positive (GP) pathogens are less accounted for in pediatric urinary tract infection (UTI), and their clinical impact is underrecognized. This study aimed to identify predictors of GP uropathogens in pediatric UTI. In this 14-year retrospective cohort of pediatric patients with UTI, we...

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Autores principales:	Yu-Lung Hsu, Shih-Ni Chang, Che-Chen Lin, Hsiao-Chuan Lin, Huan-Cheng Lai, Chin-Chi Kuo, Kao-Pin Hwang, Hsiu-Yin Chiang
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/87a7de143b144e22b59ce7e74e9fa597
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spelling	oai:doaj.org-article:87a7de143b144e22b59ce7e74e9fa5972021-12-02T15:49:31ZClinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria10.1038/s41598-021-90535-62045-2322https://doaj.org/article/87a7de143b144e22b59ce7e74e9fa5972021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-90535-6https://doaj.org/toc/2045-2322Abstract Gram-positive (GP) pathogens are less accounted for in pediatric urinary tract infection (UTI), and their clinical impact is underrecognized. This study aimed to identify predictors of GP uropathogens in pediatric UTI. In this 14-year retrospective cohort of pediatric patients with UTI, we classified first-time UTIs cases into those caused by GP or Gram-negative (GN) bacteria. We constructed a multivariable logistic regression model to predict GP UTI. We evaluated model performance through calibration and discrimination plots. We developed a nomogram to predict GP UTI that is clinically feasible. Of 3783 children with first-time UTI, 166 (4.4%) were infected by GP and 3617 (95.6%) by GN bacteria. Among children with GP UTI, the most common uropathogens were vancomycin-resistant Enterococcus faecalis (VRE) (27.1%), Staphylococcus saprophyticus (26.5%), and coagulase-negative Staphylococci (12.7%). Eight independent risk factors were associated with GP UTI: Age ≥ 24 months (odds ratio [OR]: 3.21), no prior antibiotic use (OR: 3.13), serum white blood cell (WBC) count < 14.4 × 103/μL (OR: 2.19), high sensitivity C-reactive protein (hsCRP) < 3.4 mg/dL (OR: 2.18), hemoglobin ≥ 11.3 g/dL (OR: 1.90), negative urine leukocyte esterase (OR: 3.19), negative urine nitrite (OR: 4.13), and urine WBC < 420/μL (OR: 2.37). The model exhibited good discrimination (C-statistic 0.879; 95% CI 0.845–0.913) and calibration performance. VR E. faecalis, the leading GP uropathogen causing pediatric UTI, requires early detection for infection control. Our model for predicting GP UTI can help clinicians detect GP uropathogens and administer antibiotic regimen early.Yu-Lung HsuShih-Ni ChangChe-Chen LinHsiao-Chuan LinHuan-Cheng LaiChin-Chi KuoKao-Pin HwangHsiu-Yin ChiangNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Yu-Lung Hsu Shih-Ni Chang Che-Chen Lin Hsiao-Chuan Lin Huan-Cheng Lai Chin-Chi Kuo Kao-Pin Hwang Hsiu-Yin Chiang Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria
description	Abstract Gram-positive (GP) pathogens are less accounted for in pediatric urinary tract infection (UTI), and their clinical impact is underrecognized. This study aimed to identify predictors of GP uropathogens in pediatric UTI. In this 14-year retrospective cohort of pediatric patients with UTI, we classified first-time UTIs cases into those caused by GP or Gram-negative (GN) bacteria. We constructed a multivariable logistic regression model to predict GP UTI. We evaluated model performance through calibration and discrimination plots. We developed a nomogram to predict GP UTI that is clinically feasible. Of 3783 children with first-time UTI, 166 (4.4%) were infected by GP and 3617 (95.6%) by GN bacteria. Among children with GP UTI, the most common uropathogens were vancomycin-resistant Enterococcus faecalis (VRE) (27.1%), Staphylococcus saprophyticus (26.5%), and coagulase-negative Staphylococci (12.7%). Eight independent risk factors were associated with GP UTI: Age ≥ 24 months (odds ratio [OR]: 3.21), no prior antibiotic use (OR: 3.13), serum white blood cell (WBC) count < 14.4 × 103/μL (OR: 2.19), high sensitivity C-reactive protein (hsCRP) < 3.4 mg/dL (OR: 2.18), hemoglobin ≥ 11.3 g/dL (OR: 1.90), negative urine leukocyte esterase (OR: 3.19), negative urine nitrite (OR: 4.13), and urine WBC < 420/μL (OR: 2.37). The model exhibited good discrimination (C-statistic 0.879; 95% CI 0.845–0.913) and calibration performance. VR E. faecalis, the leading GP uropathogen causing pediatric UTI, requires early detection for infection control. Our model for predicting GP UTI can help clinicians detect GP uropathogens and administer antibiotic regimen early.
format	article
author	Yu-Lung Hsu Shih-Ni Chang Che-Chen Lin Hsiao-Chuan Lin Huan-Cheng Lai Chin-Chi Kuo Kao-Pin Hwang Hsiu-Yin Chiang
author_facet	Yu-Lung Hsu Shih-Ni Chang Che-Chen Lin Hsiao-Chuan Lin Huan-Cheng Lai Chin-Chi Kuo Kao-Pin Hwang Hsiu-Yin Chiang
author_sort	Yu-Lung Hsu
title	Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria
title_short	Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria
title_full	Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria
title_fullStr	Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria
title_full_unstemmed	Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria
title_sort	clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/87a7de143b144e22b59ce7e74e9fa597
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Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria

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