Enterococcus urine cultures in febrile infants often had normal dipsticks

Researchers conducted a matched cohort study in three Spanish pediatric emergency departments from 2011 to 2023. Among 4,006 febrile infants aged 90 days or younger, 77 (1.9%) had Enterococcus spp. in urine cultures. Each was matched by age and sex with an infant whose culture grew E. coli. Comparisons were also explored by urine dipstick findings.

Abnormal dipsticks were less common with Enterococcus than with E. coli (27.3% vs. 80.5%; p<0.001). Blood inflammatory markers were also lower, largely reflecting the greater proportion of normal dipsticks. Abnormal voiding cystourethrogram findings were more frequent with Enterococcus in both the abnormal-dipstick group (70.0% vs. 27.6%; p=0.03) and the normal-dipstick group (33.3% vs. 0%; p=0.04). Among infants with abnormal dipsticks, abnormal dimercaptosuccinic acid scans and recurrent urinary tract infections were also more frequent with Enterococcus.

The findings suggest that Enterococcus-positive cultures in this population often occur with normal dipsticks, while some urinary tract abnormalities were more common than in E. coli cases. The dipstick-stratified analyses were exploratory, and the significance of Enterococcus isolates with normal dipsticks remains uncertain; the study does not establish changes to clinical management.