117 Risk Factors for Bacteremia in Young Children with a First Episode of Urinary Tract Infection (UTI)
Bibliographic record
Abstract
To determine the effect of age and renal anomalies on the risk of bacteremia in young children with a first episode of UTI. Retrospective cohort study Pediatric tertiary care center We reviewed all medical records of children 0–24 months of age treated parenterally at Sainte-Justine Hospital for a first episode of febrile UTI from April 1st 2002 to March 31st 2003. Patients were included in the study if urine culture obtained by suprapubic aspiration, bladder catheterization or clean void grew a single pathogen. Exclusion criteria were: history of prior UTI, nosocomial UTI, immunosupression, urine culture specimen taken by bag, and urine culture positive for contaminants. Patients with serum creatinine >54 mmol/L, with >grade II vesicoureteral reflux (VUR), and those with hydronephrosis were considered to have a renal anomaly. UTI-associated bacteremia was defined as presence of the same pathogen on blood and urine culture. Logistic regression was performed. A hundred and seventy nine patients were included. Median age was 6.0 months (range 0–23) and 54.2% were female. Three patients (1.7%) were on antibiotic prophylaxis prior to diagnosis. Mean WBC count was 17.9×109/L (SD 6.5) and 5 patients (2.8%) had serum creati-nine >54 mmol/L. E. coli grew on most urine cultures (93.3%). Blood culture results were available in 174 patients (97.2%). Ten patients (5.7%) had positive blood culture: 8 with E. coli, one with S. aureus and Group A Streptococcus, and one with S. epidermidis. The prevalence of UTI-associated bacteremia was 8/174 (4.6%). Voiding cystourethrogram was performed in 176 patients (98.3%) and renal ultrasound in all patients. Hydronephrosis was diagnosed in 7 patients (3.9%), 31 had grade I or II VUR (17.6%), and 16 had >grade II VUR (9.1%). Initial body temperature or WBC count were not significantly associated with UTI-associated bacteremia. Age <1 month (crude OR 2.7; 95% CI 0.5, 14.2), presence of renal anomalies (crude OR 2.2; 95% CI 0.4, 11.8), and, more specifically, presence of >grade II VUR (crude OR 3.7; 95% CI 0.7, 19.9) increased the risk of UTI-associated bacteremia, yet none of these results reached statistical significance. Similar results were obtained for renal anomalies and >grade II VUR after adjustment for age. The prevalence of UTI-associated bacteremia in children under two years of age with a first episode of febrile UTI is less than 5%. Although our sample size is too small to detect a statistically significant association, young age and the presence of renal anomalies, particularly severe VUR, may increase the risk of bacteremia. Larger cohort studies are needed to confirm these findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".