Elevated Urinary Hepcidin Level and Hypoferremia in Infants with Febrile Urinary Tract Infection: A Prospective Cohort Study.

To evaluate the kinetics of serum and urinary hepcidin levels along with anemia-related parameters during the infection course of infants with febrile urinary tract infection (UTI), we enrolled febrile infants aged one to four months in this prospective study. Febrile patients with UTI were allocated into Escherichia coli (E. coli) or non-E. coli groups according to urine culture results. Septic workup, blood hepcidin, iron profile, urinalysis, and urinary hepcidin-creatinine ratio were collected upon admission and 3 days after antibiotic treatment. In total, 118 infants were included. On admission, the febrile UTI group showed a significant reduction in serum iron level and a significant elevation of urinary hepcidin-creatinine ratio compared to the febrile control counterpart. Moreover, urinary hepcidin-creatinine ratio had the highest odds ratio, 2.01, in logistics regression analysis. After 3 days of antibiotic treatment, hemoglobin and the urinary hepcidin-creatinine ratio were significantly decreased. Patients with an E. coli UTI had a significantly decreased urinary hepcidin-creatinine ratio after 3 days of antibiotics treatment, whereas the non-E. coli group showed insignificant changes. Our study suggested that the urinary hepcidin-creatinine ratio elevated during acute febrile urinary tract infection and significantly decreased after 3 days of antibiotics treatment, especially in E. coli UTI.

C-Reactive Protein Concentration Can Help to Identify Bacteremia in Children Visiting the Emergency Department: A Single Medical Center Experience.

BACKGROUND: For febrile children who are evaluated in a pediatric emergency department (PED), blood culture can be considered the laboratory criterion standard to detect bacteremia. However, high rates of negative, false-positive, or contaminated blood cultures in children often result in this testing being noncontributory. This study determined the factors associated with true-positive blood cultures in children. METHODS: This retrospective study was conducted at a tertiary medical center's PED. The blood culture use reports were prepared by an infectious disease specialist and were classified as bacteremia, nonbacteremia, and contamination. RESULTS: We registered a total of 239,459 PED visits during the 8-year period, and 21,841 blood culture samples were taken. Of the laboratory test studies, higher C-reactive protein (CRP) levels and lower hemoglobin levels were observed in the bacteremia group compared with other groups (all P < 0.001). The cut-off value calculated for each age group was adjusted for better clinical usage and significantly improved the blood culture clinical utility documented in the following age groups: 0 to 1 years (CRP level = 30 mg/L, odds ratio [OR] = 5.4, P < 0.001), 1 to 3 years (CRP level = 45 mg/L, OR = 3.7, P < 0.001), and 12 to 18 years (CRP level = 50 mg/L, OR = 6.3, P = 0.006). Using the CRP cut-off value established in this study, we could reduce the blood culture samples in the PED by 14,108 (64.6%). CONCLUSIONS: This study provides new evidence that CRP may be a useful indicator for blood culture sampling in certain age groups and may help improve the efficiency of blood culture in the PED.

The clinical features and therapy of community-acquired gram negative bacteremia in children less than three years old.

BACKGROUND: Community-acquired Gram-Negative (GN) bacteremia caused more morbidity and mortality recently in children. The increasing drug resistance was also an important issue. However, published reference was few about children. METHODS: We conducted a retrospective study to collect febrile patients with blood culture from a pediatric emergency department during 2007∼2013, and exclude cases ever admitted to hospital within 14 days. These blood cultures all showed single GN organism. The demographic characteristics of enrolled patients and the antibiogram of pathogens were recorded, and then were compared statistically to find out the immediate and appropriate antibiotics. RESULTS: Total 143 sets of blood culture were GN bacilli and the median age of cases was 2 (IQR, 1-5) years old. Male gender was predominant. Non-fermenting Gram-negative bacilli group (NFGNB spp.), Salmonella spp. and Escherichia coli were first three common pathogens respectively. However, total 37 cases of NFGNB spp. other than Pseudomonas aeruginosa were the possible pathogens. By multiple logistic regression analysis, lower hemoglobin and higher alanine aminotransferase were significant difference between common pathogens and possible ones. Besides, the prevalent age regarding resistant strains of Escherichia coli and Pseudomonas aeruginosa were both focused on less than 1 year old. However, Salmonella spp. were prevalent in the age from 1 to 3 years old. CONCLUSIONS: For different age groups, Salmonella spp. and Escherchia coli were the most common pathogens of community-acquired GN bacteremia. For infants, Pseudomonas aeruginosa sepsis and resistant strain of Escherchia coli should be alert, and broader antibiotics should be considered.

Diagnostic values of C-reactive protein and complete blood cell to identify invasive bacterial infection in young febrile infants.

BACKGROUND: Newborn infants younger than 3 months old with a fever are frequently evaluated for the risk of invasive bacterial infections (IBIs), which include bacteremia and/or bacterial meningitis, in the pediatric emergency department (PED). The purpose of this study was to determine the individual complete blood cell count and biochemistry levels associated with IBIs in febrile infants. METHODS: We carried out this retrospective study using a pediatric emergency department at a tertiary medical center in southern Taiwan, where we also evaluated the clinical characteristics and routine blood tests between experimental groups. RESULTS: We enrolled 1231 febrile infants under the age of 3 months old in this study. We found higher body temperature, neutrophil percentage, and C-Reactive protein (CRP) values and a lower hemoglobin level in the IBIs group. Furthermore, a CRP value greater than 25 mg/L can predict IBIs at a better rate than the group with values lower than 25 mg/L (11.7% vs. 2.1%, Odds ratio 6.3, p < 0.001). CONCLUSION: This study provides evidence that a CRP level greater than 25 mg/L can more accurately predict IBIs in febrile infants. Furthermore, lower hemoglobin levels were also found in IBIs. Nevertheless, additional laboratory tests are needed to identify young febrile infants with IBIs.