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

Abstract

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.

Prevalence and predictors of urinary tract infection in full-term and preterm neonates

“…Additionally, our study revealed that the rate of UTI was non-significantly higher among fullterm neonates. In contrast, Mohseny et al [3] reported a high risk (11.3%) of UTI in NICU-admitted premature infants (less than 32 weeks) with central line and suspected sepsis. They attributed this high frequency to the presence of many risk factors for infection in preterm neonates.…”

“…However, the true prevalence of UTI in preterm neonates is difficult to determine, as sterile urine cultures are not reliably obtained in all suspected sepsis assessments. The assumed complications of sterile catheterization or suprapubic aspiration hinder urine collection, and alternative collection methods such as bag collection have high rates of contamination [3].…”

Urinary Tract Infection in Children

“…Risk factors for bacteremia include prematurity, young age (< 1 year), and high serum creatinine at presentation [109]. Late-onset sepsis due to UTI is not uncommon in infants with a gestational age of less than 32 weeks [110]. Febrile convulsion may occur in young children with high fever from pyelonephritis [111, 112].…”

Urinary Tract Infection due to Extended-spectrum Beta-lactamase Producing Organisms is a Risk Factor for Bacteraemia Among Patients with Type 2 Diabetes Mellitus

“…Bacteramia is not uncommon in UTI, both in community and hospital settings and in all age groupsadults, elderly and neonates; but the burden varied widely in different studies. [11][12][13] Generally, outcome of UTI complicated by bacteramia is worse than those without. 14 In the present study, we found nearly 7% of our type 2 diabetic subjects diagnosed with UTI had concomitant bacteramia.…”