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

BACKGROUND/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 degrees C vs. 38.9 degrees C; p<0.01), higher white cell counts (18.86 x 10(9)/L vs. 15.08 x 10(9)/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.