Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria.

ABSTRACT

Gram-positive (GP) pathogens are less accounted for in pediatric urinary tract infection (UTI), and their clinical impact is underrecognized. This study aimed to identify predictors of GP uropathogens in pediatric UTI. In this 14-year retrospective cohort of pediatric patients with UTI, we classified first-time UTIs cases into those caused by GP or Gram-negative (GN) bacteria. We constructed a multivariable logistic regression model to predict GP UTI. We evaluated model performance through calibration and discrimination plots. We developed a nomogram to predict GP UTI that is clinically feasible. Of 3783 children with first-time UTI, 166 (4.4%) were infected by GP and 3617 (95.6%) by GN bacteria. Among children with GP UTI, the most common uropathogens were vancomycin-resistant Enterococcus faecalis (VRE) (27.1%), Staphylococcus saprophyticus (26.5%), and coagulase-negative Staphylococci (12.7%). Eight independent risk factors were associated with GP UTI Age ≥ 24 months (odds ratio [OR] 3.21), no prior antibiotic use (OR 3.13), serum white blood cell (WBC) count < 14.4 × 103/µL (OR 2.19), high sensitivity C-reactive protein (hsCRP) < 3.4 mg/dL (OR 2.18), hemoglobin ≥ 11.3 g/dL (OR 1.90), negative urine leukocyte esterase (OR 3.19), negative urine nitrite (OR 4.13), and urine WBC < 420/µL (OR 2.37). The model exhibited good discrimination (C-statistic 0.879; 95% CI 0.845-0.913) and calibration performance. VR E. faecalis, the leading GP uropathogen causing pediatric UTI, requires early detection for infection control. Our model for predicting GP UTI can help clinicians detect GP uropathogens and administer antibiotic regimen early.