Introduction: There are several predisposing factors in the urinary tract for the presence of bacteria, including lithogenic urine, such as hypocitraturia.
Corynebacterium spp are currently described as associated with infection in relation to instrumental manipulation of the urinary tract, such as C. amycolatum.

Clinical case: A thirteen-year-old adolescent with renal colic clinic, who needs admission for pain control. The colic is in the context of a family history of calcium lithiasis, in the urine the monomicrobial isolation of Corynebacterium aurimucosum was obtained in two repeated urine samples. Only with adequate antibiotic treatment according to antibiogram, amoxicillin-clavulanic acid, colic pain and dysuria disappeared.

Conclusion: Corynebacterium aurimucosum is a bacterium typical of the saprophytic flora of the female urogenital apparatus, in our case is associated with the clinic of renal colic and urinary infection. In certain situations, some low virulent germs and even urogenital commensals could behave as pathogens. This underlines the importance of collecting a urine culture prior to the initiation of empirical antibiotic therapy, at least in certain risk circumstances, such as prelithogenic urine.

M.A. Zafra Anta. Servicio de Pediatría. Hospital Universitario de Fuenlabrada. Camino del Molino, 2. 28942 Fuenlabrada. Madrid.
Correo electrónico: miguelzafraanta@gmail.com

Objective: To study the rate of bacterial meningitis among infants aged 0-3 months with suspicion of urinary tract infection.

Methods: This retrospective chart review involved all children younger than 3 months with pathologic rapid urine testing by urethral catheterization in the emergency department. Lumbar puncture was performed in all children <1 month and every child 1-3 months with septic appearance. The study was conducted from October 2004 to July 2010.

Results: The study sample included 290 children with suspicion of urinary tract infection, of whom 76% boys and 24% girls; 43% of all patients were younger than one month. Urinary tract infection was confirmed by positive urine culture in 230 children, 9 of whom (3.2%) had bacteraemia associated. Lumbar puncture was performed on 167 patients (58%), of whom 7 (4%) had CSF pleocytosis. All CSF cultures were negative except of a case of a neonate 24 days old with meningitis and urinary tract infection caused by Escherichia coli.

Conclusions: The incidence of bacterial meningitis among infants aged 0-3 months with suspicion of urinary tract infection was 0.6% in our study. It is important to reconsider the performance of lumbar puncture systematically in these children, although it is still need in children aged less than 1 month and in cases where there is clinical or laboratory test suspicion of serious bacterial infection.

Objectives: To determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of two tests for rapid diagnosis of urinary tract infection (UTI) (reactive strip and Gram stain), as well as their concordance with urine culture.

Material and methods: We carried out a prospective, observational study of unweaned babies <3 months old who presented suggestive clinical signs of UTI. Urine was collected from all patients under sterile conditions performing a reactive strip, Gram stain and urine culture. Epidemiological data as well as the results of the three tests were collected. Positive urine culture results confirm the existence of infection. In order to determine the sensitivity, specificity, PPV and NPV of the different tests we used contingency tables. Statistical differences among sensitivity results were analyzed by means of the Chi-square test and concordance was evaluated using the Kappa index.

Results: We analyzed 151 urine samples, 55.6% of male patients and 44.3% of females with a mean age of 35 days (25-50). UTI was confirmed in 20.5%. The sensitivity of the reactive strip was of 51.6% (34.8%-68%) and that of Gram stain of 87.1% (71.1%-94.9%), with a statistically significant difference (p <0.02). Concordance between the reactive strip and urine culture was moderate, with a Kappa index of 0.499, whereas concordance between Gram stain and urine culture was satisfactory, with a Kappa index of 0.856.

Conclusions: Urine Gram stain can be very helpful for the rapid diagnosis of UTI in unweaned babies below 3 months.

The urine reactive strip as the only diagnostic test may not be sufficient in this age group.

Introduction: In our search for alternatives to antibiotic chemoprophylaxis to prevent pediatric urinary infections, we have started to use a concentrated extract of North American red cranberries containing 118 mg of proanthocyanidins, the before mentioned inhibit the adherence of P-fimbriated Escherichia coli to the urinary tract wall.

Objectives: To observe the effectiveness and tolerance of a concentrated extract of cranberries in children with frequent urinary tract infections.

Material and methods: We selected groups of patients with frequently recurrent urinary infections, with no malformative systemic pathologies and either neuropathic bladder, lithiasis or renal failure. The observational study was conducted over one year in 62 children from 5 to 17 years old.

Results: The results were quite satisfactory: 100% prevention of acute pyelonephritis, and 92% absence of symptomatic infections.

Conclusions: We have been able to confirm the high effectiveness of the product, the absence of adverse effects, an excellent acceptance by the parents and patients regarding a long-term treatment, and a very low rate of dropouts.
Prospective double-blind randomized and placebo-controlled trials will be required in order to issue recommendations supported by a high degree of evidence.