Host and Bacterial Markers that Differ in Children with Cystitis and Pyelonephritis

To determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis. We enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to ident...

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Bibliographic Details
Published in:The Journal of pediatrics 2019-06, Vol.209, p.146-153.e1
Main Authors: Shaikh, Nader, Martin, Judith M., Hoberman, Alejandro, Skae, Megan, Milkovich, Linette, Nowalk, Andrew, McElheny, Christi, Hickey, Robert W., Kearney, Diana, Majd, Massoud, Shalaby-Rana, Eglal, Tseng, George, Alcorn, John F., Kolls, Jay, Kurs-Lasky, Marcia, Huo, Zhiguang, Horne, William, Lockhart, Greg, Pohl, Hans, Shope, Timothy R.
Format: Article
Language:English
Subjects:
Acute Disease
Bacterial Infections - blood
Bacterial Infections - urine
Biomarkers - analysis
calculator
Child, Preschool
Cystitis - blood
Cystitis - diagnosis
Cystitis - microbiology
Cystitis - urine
Diagnosis, Differential
diagnostic accuracy
Female
Humans
Infant
Male
Pilot Projects
prediction rule
Prospective Studies
Pyelonephritis - blood
Pyelonephritis - chemically induced
Pyelonephritis - microbiology
Pyelonephritis - urine
risk
Urinary Tract Infections - blood
Urinary Tract Infections - urine
UTI
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Summary:To determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis. We enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to identify those with pyelonephritis. Renal scans were interpreted centrally by 2 experts. We measured inflammatory proteins in blood and urine using LUMINEX or an enzyme-linked immunosorbent assay. We evaluated serum RNA expression using RNA sequencing in a subset of children. Finally, for children with Escherichia coli isolated from urine cultures, we performed a polymerase chain reaction for 4 previously identified virulence genes. Urinary markers that best differentiated pyelonephritis from cystitis included chemokine (C-X-C motif) ligand (CXCL)1, CXCL9, CXCL12, C-C motif chemokine ligand 2, INF γ, and IL-15. Serum procalcitonin was the best serum marker for pyelonephritis. Genes in the interferon-γ pathway were upregulated in serum of children with pyelonephritis. The presence of E coli virulence genes did not correlate with pyelonephritis. Immune response to pyelonephritis and cystitis differs quantitatively and qualitatively; this may be useful in differentiating these 2 conditions.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2019.01.012