Bacteremia associated with increased blood creatinine levels
Averbuch D. Pediatr Infect Dis J. 2014;doi:10.1097/INF.0000000000000316.
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April 4, 2014
Above normal blood creatinine levels at hospital admission was associated with bacteremia in infants aged 0 to 2 months with urinary tract infections, according to recent study findings published in The Pediatric Infectious Disease Journal.
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Diana Averbuch, MD, of the pediatric infectious diseases unit at Hadassah-Hebrew University Medical Center in Israel, and colleagues evaluated 82 episodes of UTI among 81 infants to determine the frequency of bacteremia. Significant findings included that more than half of patients were males (72.8%); nearly half of the episodes occurred in patients of non-Jewish origin (42.7%); most episodes were in patients aged 0 to 30 days (70.7%); and 29.3% were in patients aged 31 to 60 days.
Diana Averbuch
The most common sign and symptom was fever (81.7%), followed by apathy (28%); signs of respiratory tract infections (18.3%); jaundice (17%); cyanosis or apnea (10.9%); diarrhea (8.5%); vomiting (7.3%); pallor (4.9%); cutis marmorata (4.9%); dehydration (3.7%); dyspnea (2.4%); and hypothermia (1.2%). Prior to admission, complaint time was 1 to 4 days in 79 episodes.
Urine was most commonly collected by suprapubic aspiration (53.7%) followed by newly inserted catheters (34.1%), and either suprapubic aspiration or catheter but unspecified (12.2%).
The most commonly identified bacteria from urine cultures included Escherichia coli (70.7%), Enterococcus faecalis (13.4%), and Klebsiella pneumoniae (8.5%). Overall, 81 episodes had blood cultures available and 17.3% had E. coli cultured; however, no other pathogens were isolated.
Twelve patients with bacteremia had ultrasound available and it was abnormal in 33.3%. Thirty-seven non-bacteremic patients had ultrasound available and it was abnormal in 21.6%.
Patients with bacteremia had significantly higher blood creatinine levels at admission. The only factors significantly associated with bacteremia were increased blood creatinine levels at admission (P=.004) and non-Jewish origin (P=.006). Circumcision rates were 37.5% among bacteremic boys and 66.7% among non-bacteremic boys; however, it was not associated with bacteremia.
“We have no explanation as to why non-Jewish origin was found to be associated with bacteremia,” the researchers wrote. “Delay in diagnosis could explain this difference — but duration of symptoms until emergency room presentation was similar in infants of non-Jewish and Jewish origin (P=.431). Based on our current results, it seems that circumcision does not have influence on the occurrence of bacteremia.”
Overall, five patients were hospitalized in the ICU during their UTI episodes because of apnea, bradycardia, or desaturation. None were bacteremic. No deaths occurred during the study period and all patients recovered without sequela.
“In conclusion, we showed that bacteremia in infants aged 0-60 days admitted with UTI is associated with blood creatinine above the 50th percentile appropriate for age, with longer time to defervescence and with longer hospitalization,” the researchers wrote. “Increased blood creatinine levels on admission can provide an additions clue, independent of personal judgment, to help identify infants at higher risk for bacteremia, prolonged hospitalization and potential complications. Prospective analysis of blood creatinine at admission of infants with UTI is required to confirm our data.”