Management and outcome of positive urine cultures in a neonatal intensive care unit

Abstract

The diagnosis of UTI in NICU is hampered by use of urine collection methods that are subject to contamination. Outcome is generally excellent, but there is a great need for guidelines on management of positive urine cultures in the NICU.

Clinical predictors of urinary tract infection in the neonatal intensive care unit

“…Information on coexisting medical conditions, clinical factors, and screening test results were included as predictive factors based on prior association with UTI [8,11,13]; their association with a more severe neonatal course, which may change the underlying risk of an infant having a UTI or whether the infant receives a sepsis workup; or because their occurrence would result in a sepsis workup in an infant. Daily clinical and laboratory data were abstracted for the day prior to culture and the day of culture.…”

“…Daily clinical and laboratory data were abstracted for the day prior to culture and the day of culture. Clinical factors reported to be associated with UTI in other neonatal and pediatric populations were included: gestational age, birth weight, chronological age, male sex, exposure to indwelling devices, and exposure to enteral feeds [11,13]. Bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) are commonly measured short-term outcomes in premature neonates that are associated with more severe clinical course and may change the threshold for performing a sepsis evaluation.…”

“…Based on the results of these screening tests, further workup including a urine or cerebrospinal fluid culture may be ordered. However, published studies of the very low birth weight NICU population suggest that less than 50% of patients with positive urine cultures have concomitant positive blood cultures [8,11-13]. This suggests that many UTI are missed when only blood cultures are obtained in late-onset sepsis evaluations in this population.…”

Évaluation des pratiques de prise en charge des infections urinaires de l’enfant

“…Bien que son usage dans les SAU pédiatriques n'ait pas été banni de certaines recommandations européennes [3,12,19], le sachet collecteur induit un risque plus important de contamination significative du prélèvement par les bactéries périnéales ou urétrales [20]. Sa spécificité est en effet de seulement 14 à 84% selon les études, alors que d'autres modes de recueil ont une spécificité bien meilleure (99% pour le sondage urétral) [4].…”

“…En cas de méningite associée, la céphalosporine choisie devait être le céfotaxime. Protocole en vigueur dans le service de néonatalogie du CHRU de Lille, défini comme le protocole à suivre pour cette étude, en l'absence de consensus national ou international thérapeutique [12,13].…”