Objective Our objective was to evaluate the incidence of urinary tract infections (UTIs) in low birth weight (LBW) neonates and to evaluate the compliance of neonatal intensive care unit (NICU) providers in performing urine cultures as a part of late-onset sepsis (LOS) evaluations following an educational intervention. Study Design A retrospective chart review for all LBW infants undergoing LOS evaluations was performed. An educational intervention was conducted to encourage NICU providers to perform urine cultures in LOS evaluations. Prospective chart reviews were conducted following the intervention to assess compliance with the urine culture directive and the incidence of UTIs before and after the intervention. Results Rate of UTIs among LBW neonates was 1.3% for the entire study period and typical uropathogens were the cause. UTIs were found concurrently with bacteremia in only 33.3% of cases and showed a predilection for male infants when analyzing based on the number of infections. Urine cultures were performed in 20% of LOS evaluations prior to our educational intervention and increased to 57% (p < 0.0001) postintervention. Conclusion An educational intervention is effective at increasing the rate of obtaining urine cultures with LOS evaluations. Performing these cultures reveals that UTIs in LBW neonates are common without bacteremia and can be missed if they are omitted from LOS evaluations. Key Points
Since 1997 it has been recommended by the CDC that pediatric patients over the age of two with certain chronic illnesses, including diabetes mellitus, receive 23 valent pneumococcal polysaccharide vaccine (PPSV23) in addition to the PCV7/PCV13 primary series given to all children (1). This recommendation is attributable to the need to prevent invasive pneumococcal infection in these susceptible populations. School aged children are frequently colonized with Streptococcus pneumonia bacteria (2), and those with diabetes are at a greater risk of developing serious pneumococcal infections (3). There is some evidence in the international literature suggesting a lack of compliance with this guideline (4). Our aim was to assess the pneumococcal polysaccharide vaccination rate among a cohort of diabetic patients in our pediatric endocrinology clinic. We conducted a retrospective chart review of all diabetic patients seen at the pediatric endocrinology clinic in Staten Island, New York between the ages of 2-20. We excluded those who had no follow up for 1 year. We collected data including age of diagnosis, type of diabetes, and vaccination records. Vaccine records were obtained from the New York Citywide Immunization Registry (CIR). Out of all the diabetics in our clinic, 126 charts met eligibility criteria. Of the 126 patients, 105 had type 1 diabetes mellitus, 14 were type 2, and 7 were other (including MODY and secondary to other underlying conditions). The type 1 diabetics had the lowest mean age of diagnosis of 7 years, compared with mean age of 12 years for the other two groups. Of the 126 patients, only 3.2% (95% CI: 0.9% , 7.9%) were found to have received the PPSV23, all type 1 diabetics. Our results show a poor rate of PPSV23 vaccination among pediatric patients with diabetes. Additionally, as the age of diagnosis is lowest in type 1 diabetics, most type 1 diabetics have a longer period of exposure to potentially serious pneumococcal infections. Thus, it is imperative that all diabetics, especially type 1 diabetics, receive the vaccine as early as possible following diagnosis for optimal protection. Our findings, in combination with the limited additional pediatric literature published to date, suggest that these low vaccination rates are likely generalizable to other geographic regions as well as other chronic illnesses in which children have increased susceptibility to pneumococcal disease (5, 6). Given these results, we recommend endocrinologists and pediatricians alike take steps to ensure adherence to the PPSV23 recommendations. References: 1) MMWR Morb Mortal Wkly Rep. 2010; 59 (RR-11). 2) Principi N et al. Human Vacc Imm . 2016; 12 (2): 293-300. 3) Seminog OO, Goldarce MJ. Diabetic Med . 2013; 30(12):1412-9. 4) Wolkers PCB et al. Rev Esc Enferm USP . 2017; 51:e03249. 5)...
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