DOI: 10.1111/apa.70816 ISSN: 0803-5253

Positive Urine Cultures for Enterococcus spp. vs. Escherichia coli in Febrile Infants Younger Than 90 Days: A Matched Cohort Study

María Suárez‐Bustamante Huélamo, José Antonio Alonso‐Cadenas, Andrea Trujillo Montoro, Cristina Ibarzo Port, Alexia Hernández Pernía, Santiago Mintegi, Roberto Velasco, Borja Gómez
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ABSTRACT

Aim

To compare febrile infants aged 90 days or younger with Enterococcus spp. or Escherichia coli in urine cultures, overall and by urine dipstick findings.

Methods

Matched cohort study in three Spanish paediatric emergency departments (2011–2023). Infants with Enterococcus spp. were matched 1:1 by age and sex with infants with E. coli and compared using paired tests; dipstick‐stratified analyses were exploratory.

Results

Of 4006 febrile infants, 77 (1.9%) had Enterococcus spp. Abnormal dipstick findings were less frequent than with E. coli (27.3% vs. 80.5%; p  < 0.001), and blood inflammatory markers were lower, largely reflecting the higher proportion of normal dipsticks. Abnormal voiding cystourethrogram findings were more frequent with Enterococcus spp., with abnormal (70.0% vs. 27.6%; p  = 0.03) and normal dipsticks (33.3% vs. 0%; p  = 0.04). With abnormal dipsticks, abnormal dimercaptosuccinic acid scans (6/11 vs. 0/17; p  = 0.001) and recurrent urinary tract infections (33.3% vs. 8.1%; p  = 0.009) were more frequent with Enterococcus spp.

Conclusion

In these infants, Enterococcus spp. in urine usually had a normal dipstick but was associated with more urinary tract abnormalities than E. coli . Enterococcal infections with abnormal dipsticks were associated with more renal scan abnormalities and recurrences; the significance of isolates with normal dipsticks remains uncertain.

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