Differences in Age Groups and Clinical Manifestation of E.Coli and Non-E.coli-induced Pediatric Acute Pyelonephritis

Abstract

Aim: To evaluate the diferences between E. Coli and NonE. coli-induced paediatric acute pyelonephritis (APN) by analysing age groups and clinical fndings. Methods:The research method is a retrospective study. Medical history data was collected of children with APN treated at LUHS Kaunas Clinics Department of Children diseases in 2020-01-01 – 2021-12-31 (n=270). The subjects were divided into four age groups: 28 days to 6 months, 7 months to 1 year, 2 years to 5 years, and 6 years to 17 years. Signifcant bacterial growth in urine was detected at > 105 colony-forming units (CFU)/ml in a mid-portion urine culture and > 104 CFU/ml in a bladder catheterization culture. Statistical analysis was performed using the “IBM SPSS Statistics” program. The χ2 criterion was applied. The results were considered statistically signifcant if p < 0.05. Results: After analysing the results of 266 urine cultures, signifcant bacterial growth was observed in 204 (76.7 %) cultures. E. coli was the cause of 170 (83.3 %) cases of APN. E. faecalis was identifed as the second most common cause of APN. APN caused by agents other than E. coli occurred more frequently in children under 6 months of age, compared to other age groups (p=0.01). Additionally, non-E. coli-induced APN was statistically more prevalent in boys (20, 58.8 %), than in girls (14, 41.2 %) (p<0.001), and in cases lacking leukocyturia (p=0.02). All patients with non-E. coli representatives such as E. faecium and S. agalactiae, in the urine culture were diagnosed with hydronephrosis by ultrasound examination (p=0.03). It was found that in cases where causative agent was not E. coli, more changes were observed in renal ultrasound examination, although the results were not statistically signifcant. Conclusion: Non-E. Coli-induced APN was more frequently observed in younger patients and those lacking leukocyturia. It was found that agents other than E. coli are associated with changes in renal ultrasound, but a statistically signifcant result was not achieved.