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      Risk of urinary tract infection in infants and children with acute bronchiolitis

      research-article
      , MD FAAP 1 , 2 , , MD FRCP(C) 1 , 2 , , MD 1 , , MD 1 , , PhD 3
      Paediatrics & Child Health
      Pulsus Group Inc
      Bronchiolitis, Infection, Urine

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          Abstract

          OBJECTIVES:

          To estimate the prevalence of urinary tract infection in infants and children with bronchiolitis.

          METHODS:

          A retrospective cross-sectional study involving patients zero to 24 months of age who were hospitalized with acute bronchiolitis was conducted.

          RESULTS:

          A total of 835 paediatric patients with acute bronchiolitis were admitted to the paediatric ward between January 2010 and December 2012. The mean (± SD) age at diagnosis was 3.47±2.99 months. There were 325 (39%) girls and 510 (61%) boys. For the purpose of data analysis, the patient population was divided into three groups: group 1 included children hospitalized with respiratory syncytial virus (RSV) bronchiolitis; group 2 included children hospitalized with clinical bronchiolitis with no virus detected; and group 3 included children hospitalized with clinical bronchiolitis due to a respiratory virus other than RSV. Results revealed that urinary tract infection was present in 10% of patients, and was most common in group 3 (13.4%) followed by group 2 (9.7%), and was least common in group 1 (6%) (P=0.030).

          CONCLUSIONS:

          The possibility of a urinary tract infection should be considered in a febrile child with a diagnosis of bronchiolitis, particularly if the trigger is a respiratory virus other than RSV.

          Translated abstract

          OBJECTIF :

          Évaluer la prévalence d’infections urinaires chez les nourrissons atteints de bronchiolite.

          MÉTHODOLOGIE :

          Les chercheurs ont effectué une étude transversale rétrospective auprès de patients de zéro à 24 mois hospitalisés en raison d’une bronchiolite aiguë.

          RÉSULTATS :

          Au total, 835 patients d’âge pédiatrique atteints de bronchiolite aiguë ont été hospitalisés dans l’aile pédiatrique entre janvier 2010 et décembre 2012. D’un âge moyen (± ÉT) de 3,47±2,99 mois au diagnostic, ils étaient répartis entre 325 filles (39 %) et 510 garçons (61 %). Pour les besoins de l’analyse de données, la population de patients était divisée entre trois groupes : le groupe 1 se composait de nourrissons hospitalisés en raison d’une bronchiolite à virus syncytial respiratoire (VRS), le groupe 2, de nourrissons hospitalisés en raison d’une bronchiolite clinique sans qu’un virus soit décelé et le groupe 3, de nourrissons hospitalisés en raison d’une bronchiolite clinique causée par un autre virus respiratoire que le VRS. Les résultats ont révélé une infection urinaire chez 10 % des patients, plus courante dans le groupe 3 (13,4 %), puis le groupe 2 (9,7 %), et moins courante dans le groupe 1 (6 %) (P=0,030).

          CONCLUSIONS :

          Il faut envisager la possibilité d’infection urinaire chez un nourrisson fébrile atteint d’une bronchiolite diagnostiquée, particulièrement si elle est déclenchée par un autre virus respiratoire que le VRS.

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          Most cited references23

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          Bronchiolitis-associated hospitalizations among US children, 1980-1996.

          Respiratory syncytial virus (RSV) causes more lower respiratory tract infections, often manifested as bronchiolitis, among young children than any other pathogen. Few national estimates exist of the hospitalizations attributable to RSV, and recent advances in prophylaxis warrant an update of these estimates. To describe rates of bronchiolitis-associated hospitalizations and to estimate current hospitalizations associated with RSV infection. Descriptive analysis of US National Hospital Discharge Survey data from 1980 through 1996. Children younger than 5 years who were hospitalized in short-stay, non-federal hospitals for bronchiolitis. Bronchiolitis-associated hospitalization rates by age and year. During the 17-year study period, an estimated 1.65 million hospitalizations for bronchiolitis occurred among children younger than 5 years, accounting for 7.0 million inpatient days. Fifty-seven percent of these hospitalizations occurred among children younger than 6 months and 81 % among those younger than 1 year. Among children younger than 1 year, annual bronchiolitis hospitalization rates increased 2.4-fold, from 12.9 per 1000 in 1980 to 31.2 per 1000 in 1996. During 1988-1996, infant hospitalization rates for bronchiolitis increased significantly (P for trend <.001), while hospitalization rates for lower respiratory tract diseases excluding bronchiolitis did not vary significantly (P for trend = .20). The proportion of hospitalizations for lower respiratory tract illnesses among children younger than 1 year associated with bronchiolitis increased from 22.2% in 1980 to 47.4% in 1996; among total hospitalizations, this proportion increased from 5.4% to 16.4%. Averaging bronchiolitis hospitalizations during 1994-1996 and assuming that RSV was the etiologic agent in 50% to 80% of November through April hospitalizations, an estimated 51, 240 to 81, 985 annual bronchiolitis hospitalizations among children younger than 1 year were related to RSV infection. During 1980-1996, rates of hospitalization of infants with bronchiolitis increased substantially, as did the proportion of total and lower respiratory tract hospitalizations associated with bronchiolitis. Annual bronchiolitis hospitalizations associated with RSV infection among infants may be greater than previous estimates for RSV bronchiolitis and pneumonia hospitalizations combined.
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            Prevalence of urinary tract infection in childhood: a meta-analysis.

            Knowledge of baseline risk of urinary tract infection can help clinicians make informed diagnostic and therapeutic decisions. We conducted a meta-analysis to determine the pooled prevalence of urinary tract infection (UTI) in children by age, gender, race, and circumcision status. MEDLINE and EMBASE databases were searched for articles about pediatric urinary tract infection. Search terms included urinary tract infection, cystitis, pyelonephritis, prevalence and incidence. We included articles in our review if they contained data on the prevalence of UTI in children 0-19 years of age presenting with symptoms of UTI. Of the 51 articles with data on UTI prevalence, 18 met all inclusion criteria. Two evaluators independently reviewed, rated, and abstracted data from each article. Among infants presenting with fever, the overall prevalence (and 95% confidence interval) of UTI was 7.0% (CI: 5.5-8.4). The pooled prevalence rates of febrile UTIs in females aged 0-3 months, 3-6 months, 6-12 months, and >12 months was 7.5%, 5.7%, 8.3%, and 2.1% respectively. Among febrile male infants less than 3 months of age, 2.4% (CI: 1.4-3.5) of circumcised males and 20.1% (CI: 16.8-23.4) of uncircumcised males had a UTI. For the 4 studies that reported UTI prevalence by race, UTI rates were higher among white infants 8.0% (CI: 5.1-11.0) than among black infants 4.7% (CI: 2.1-7.3). Among older children (<19 years) with urinary symptoms, the pooled prevalence of UTI (both febrile and afebrile) was 7.8% (CI: 6.6-8.9). Prevalence rates of UTI varied by age, gender, race, and circumcision status. Uncircumcised male infants less than 3 months of age and females less than 12 months of age had the highest baseline prevalence of UTI. Prevalence estimates can help clinicians make informed decisions regarding diagnostic testing in children presenting with signs and symptoms of urinary tract infection.
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              Recent trends in severe respiratory syncytial virus (RSV) among US infants, 1997 to 2000.

              To provide current estimates of the incidence, associated risk factors, and costs of severe respiratory syncytial virus (RSV) infections among infants in the United States, defined as emergency department (ED) visits, hospitalization, and death. Retrospective analysis of National Hospital Ambulatory Medical Care Survey data 1997 to 2000; National Hospital Discharge Survey data 1997 to 2000; Perinatal Mortality Linked Files 1998 to 1999. The Hospital Cost Utilization Inpatient Sample data 1997 to 2000 were used to estimate hospitalization costs, and the 2001 Medicare fee schedule was used to estimate ED visit costs. Census data were used for population estimates. Between 1997 and 2000, there were 718,008 ED visits by infants with lower respiratory infection diagnoses during the RSV season (22.8/1000), and 29% were admitted. Costs of ED visits were approximately 202 million US dollars. RSV bronchiolitis was the leading cause of infant hospitalization annually. Total hospital charges for RSV-coded primary diagnoses during the 4 years were more than 2.6 billion US dollars. An estimated 390 RSV-associated postneonatal deaths occurred in 1999. Low birth weight and prematurity significantly increased RSV-associated mortality rates. RSV is a major cause of infant morbidity and mortality. Severe RSV is highest among infants of black mothers and Medicaid-insured infants. Prematurity and low birth weight significantly increase RSV mortality rates.
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                Author and article information

                Journal
                Paediatr Child Health
                Paediatr Child Health
                PGI
                Paediatrics & Child Health
                Pulsus Group Inc
                1205-7088
                1918-1485
                Jun-Jul 2015
                : 20
                : 5
                : e25-e29
                Affiliations
                [1 ]Department of Pediatrics, Academic General Pediatrics Division, Hamad Medical Corporation, Doha, Qatar;
                [2 ]Weill-Cornell Medical College-Qatar;
                [3 ]Medical Research Center, Hamad Medical Corporation, Doha, Qatar
                Author notes
                Correspondence: Dr Mohamed A Hendaus, Department of Pediatrics, Academic General Pediatrics Division, Hamad Medical Corporation, Doha, Qatar 3050. Telephone 974-4439-2239; fax 974-4443-9571, e-mail: mhendaus@ 123456yahoo.com
                Article
                pch-20-e25
                10.1093/pch/20.5.e25
                4472059
                26175566
                eb9e699b-e154-4cd2-acc3-25eb6bce8306
                © 2015, Pulsus Group Inc. All rights reserved
                History
                : 13 April 2015
                Categories
                Original Article

                bronchiolitis,infection,urine
                bronchiolitis, infection, urine

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