Is it Justified to Include Urine Cultures in Early (&lt; 72 Hours) Neonatal Sepsis Evaluations of Term and Late Preterm Infants?

Riskin, Arieh; Toropine, Arina; Bader, David A.; Hemo, Miri; Srugo, Isaac; Kugelman, Amir

doi:10.1055/s-0032-1329180

Cited by 9 publications

(5 citation statements)

References 12 publications

(25 reference statements)

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“…Neonates with suspected sepsis in the first few days of life (Ͻ72 h) do not need urine obtained for chemical and microscopic analysis because most infections of the urinary tract in this population are secondary to hematogenous seeding of the kidney by bacteremia (155)(156)(157). However, subsequent workups for sepsis should include careful consideration of a urinalysis and urine culture, especially in symptomatic neonates.…”

Section: Urine Testingmentioning

confidence: 99%

Early-Onset Neonatal Sepsis

et al. 2014

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SUMMARY Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.

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Section: Urine Testingmentioning

confidence: 99%

Early-Onset Neonatal Sepsis

et al. 2014

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“…5,6 Occurrence of UTIs in the first 3 days of life is reportedly rare (0%–1%) in the United States 7,8 and up to 1.8% in developing countries. 9,10 Even in premature infants, virtually no cases are detected in the first 24 hours of life. 8 …”

Section: Epidemiology and Risk Factors For Urinary Tract Infections Imentioning

confidence: 99%

Urinary Tract Infections in the Infant

Arshad

Seed

2015

Clinics in Perinatology

109

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“…The overall occurrence of UTI is reported higher in preterm infants as compared to term infants [ 4 ]. In both groups, the incidence of UTI increases with postnatal age, varying from 1 to 2% in the first 72 h after birth up to 25% later on [ 4 , 5 ]. Therefore, routine early-onset sepsis (EOS) work-up in infants does not include urine cultures [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…In both groups, the incidence of UTI increases with postnatal age, varying from 1 to 2% in the first 72 h after birth up to 25% later on [ 4 , 5 ]. Therefore, routine early-onset sepsis (EOS) work-up in infants does not include urine cultures [ 5 ]. UTI in preterm infants may be secondary to bacteremia, but it may also start as primary infection in the urinary tract leading to bacteremia [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…In preterm infants admitted at the NICU, data regarding urine cultures in the evaluation of late-onset sepsis (LOS) are limited [ 7 ]. Nevertheless, since the overall risk of UTI rises with decreasing gestational age, low birth weight, and postnatal age above 72 h after birth, urine should be analyzed when LOS is suspected [ 4 , 5 , 7 , 8 ]. However, the presence of other risk factors for infection might make clinicians reluctant to obtain urine cultures during the primary sepsis evaluation [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Late-onset sepsis due to urinary tract infection in very preterm neonates is not uncommon

et al. 2017

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Urinary tract infection (UTI) is a common cause of sepsis in infants. Premature infants hospitalized at a neonatal intensive care unit often have risk factors for infection. In this group, the risk of UTI is not clearly known, and guidelines for urine analysis are not unanimous. We aimed to identify the risk of UTI in premature infants with central lines, suspected of late-onset sepsis. We analyzed all 1402 infants admitted to our hospital between 2006 and 2014 with a gestational age less than 32 weeks. Six hundred sixty-two episodes of sepsis evaluations were found with an unknown source of infection based on clinical symptoms. In half of this group, urine analysis was performed identifying UTI in 11.3% (24/212). In 13 of these infants (54%) with a UTI, infection was due to Candida albicans. In at least four episodes, the diagnosis and treatment would have been delayed if urine analysis had not been performed. Conclusion: Based on these findings, we conclude that in premature infants with central lines, urine analysis should be performed routinely when signs of infection occur beyond 72 h after birth. Urine collection should not be delayed and cultures should preferably be performed before the start of the antibiotic treatment. What is known: • In preterm infants, the presence of other risk factors for infection might make clinicians reluctant to obtain urine cultures during sepsis evaluation. • An internal survey demonstrated that there is no consensus within the NICUs in The Netherlands regarding urine analysis as part of LOS work-up. What is new: • The risk of UTI in the NICU population (11.3%) is comparable to term infants; therefore, urine analysis should be performed routinely when LOS is suspected. • Candida albicans was the most frequently (54%) detected pathogen causing UTI in this population.

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Is it Justified to Include Urine Cultures in Early (< 72 Hours) Neonatal Sepsis Evaluations of Term and Late Preterm Infants?

Abstract: There seems to be no justification for routine urine culture in early neonatal sepsis workup of term and late preterm infants, unless there are accompanying clinical symptoms, usually related to neonatal jaundice.

Cited by 9 publications

References 12 publications

Early-Onset Neonatal Sepsis

Early-Onset Neonatal Sepsis

Urinary Tract Infections in the Infant

Late-onset sepsis due to urinary tract infection in very preterm neonates is not uncommon

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