Prevalence of Enterococcal Urinary Tract Infections With Positive Nitrites in Urinalysis in Pediatric Patients With High-Risk for Enterococcal Infections.

This article focuses on the prevalence of enterococcal urinary tract infections (UTIs) in high-risk pediatric patients, particularly those with congenital anomalies of the kidney and urinary tract (CAKUT) and positive nitrite tests in urinalysis. The retrospective study of 931 UTI episodes at a tertiary pediatric center found that enterococcal UTIs were uncommon in children with positive nitrites, with only 0.5% prevalence among high-risk patients, most enterococcal infections occurring in nitrite-negative cases. Given that Enterococcus spp. do not reduce nitrate to nitrite, the presence of nitrites effectively rules out enterococcal infection with high specificity. The findings suggest that empirical anti-enterococcal antibiotic therapy, such as ampicillin, may be unnecessary in high-risk children presenting with positive nitrites, potentially reducing unnecessary antibiotic use and its associated risks.