Urinary tract infection is common in VLBW infants

Drumm, Caitlin; Siddiqui, Javedan N; Desale, Sameer; Ramasethu, Jayashree

doi:10.1038/s41372-018-0226-4

Cited by 10 publications

(11 citation statements)

References 21 publications

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“…The incidence of infection and the organism distribution we report are consistent with other reports of VLBW late-onset sepsis in the time period studied, with 23% incidence of BSI and a predominance of CONS. [7][8][9] UTIs are common beyond day 3 of age, [10][11][12] and the number of VLBW infants in our study diagnosed with this infection was 10%, similar to previously reported rates 13,14 A lack of guidelines or incomplete adherence to guidelines among NICUs as to whether to obtain a urine culture when getting a blood culture for infants with suspected infection is one explanation for the practice variation we observed among centers. For the 30 cases of UTI, no blood culture results were reported, yet we found that 23% of UTIs were associated with bacteremia.…”

Section: Discussionsupporting

confidence: 87%

Meningitis, urinary tract, and bloodstream infections in very low birth weight infants enrolled in a heart rate characteristics monitoring trial

et al. 2019

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BACKGROUND: Displaying heart rate characteristic (HRC) scores was associated with lower sepsis-associated mortality in very low birth weight (VLBW) infants in a multicenter randomized controlled trial (HeRO trial). The aim of this study was to test whether HRC indices rise before diagnosis of urinary tract infection (UTI) or meningitis, with and without concomitant BSI. METHODS: Blood, urine, and cerebrospinal fluid (CSF) culture data after 3 days of age and within 120 days of study enrollment were analyzed from 2989 VLBW infants. The HRC index was analyzed 12 h prior to positive cultures compared to 36 h prior, using paired signed-rank tests. RESULTS: UTI, meningitis, and BSI were diagnosed in 10%, 2%, and 24% of infants, respectively. The mean hourly HRC index was significantly higher 12 h prior to diagnosis of UTI and BSI compared to 36 h prior (UTI 2.07 versus 1.81; BSI 2.62 versus 2.25, both p < 0.0001). The baseline HRC index was higher for meningitis, compared to UTI or BSI, but without a statistically significant rise in the day prior to meningitis diagnosis. CONCLUSIONS: In a large cohort of VLBW infants enrolled in the HeRO trial, the HRC index increased in the 24-h period prior to diagnosis of UTI and BSI but not meningitis.

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Section: Discussionsupporting

confidence: 87%

Meningitis, urinary tract, and bloodstream infections in very low birth weight infants enrolled in a heart rate characteristics monitoring trial

et al. 2019

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“…was also the most common pathogen in a single-center study of 762 VLBW infants with 66 UTIs identified between 1990 and 2001 13 and another singlecenter study of 232 VLBW infants with 32 UTIs identified between 2005 and 2015. 12 Other studies have shown E. coli to be the most common pathogen, including a single-center study of 572 VBLW infants with 20 UTIs identified conducted between 2004 and 2006. 2 The rate of Enterococcus spp.-positive urine cultures in this cohort was similar to previous studies completed in premature infants, which showed Enterococcus spp.…”

Section: Discussionmentioning

confidence: 99%

“…Longer duration of hospitalization has been shown to be associated with UTI diagnosis, which is confirmed here. 11,12 Infants with longer lengths of hospitalization have greater opportunity to develop and be diagnosed with a UTI, and likely have greater severity of illness, which may also be associated with increased UTI risk.…”

Section: Discussionmentioning

confidence: 99%

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Urinary Tract Infection Epidemiology in NICUs in the United States

Kilpatrick,

Boutzoukas,

Chan

et al. 2023

Am J Perinatol

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Objective Our objective was to characterize the incidence, associated clinical factors, timing of infection, microbiology, and incidence of concordant blood culture of urinary tract infections (UTIs) in very low birth weight (VLBW <1,500g) infants. Study Design Multicenter observational cohort study of VLBW infants with gestational age (GA) ≤32 weeks, still hospitalized on postnatal day 7, and discharged 2010 to 2018 from Pediatrix Medical Group neonatal intensive care units. Demographic and clinical characteristics of infants with and without UTI were compared. Multivariable logistic regression evaluated adjusted odds of UTI diagnosis. Results Of 86,492 included infants, 5,988 (7%) had a UTI. The most common pathogen was Enterococcus spp. (20%), followed by Escherichia coli (19%) and Klebsiella spp. (18%). Candida spp. (6%) was the most common nonbacterial pathogen. Concordant-positive blood culture was present in 8% of infants with UTI diagnoses. UTI was associated with lower GA, male sex, vaginal delivery, prenatal steroid exposure, and longer duration of hospitalization. Conclusion UTI is a common cause of infection in VLBW infants, especially among the smallest, most premature, male infants, and those with a longer duration of hospitalization. Neonatal clinicians should consider obtaining urine culture in the setting of late-onset sepsis evaluations in VLBW infants. Key Points

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“…The frequency of UTIs in the entire study population was found to be 1.3%, which is lower than other published rates in similar populations. [7][8][9] Although the UTI frequency considerably increased from 0.75% preintervention to 4.18% post-intervention, both are potentially underestimated because of the failure to obtain urine cultures leading to missed UTIs, especially in the preintervention period. When looking only at infants in whom urine cultures were sent, the rate of UTI's was 35 and 42.8%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Urinary Tract Infections in Low Birth Weight Neonates

et al. 2022

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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

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Urinary tract infection is common in VLBW infants

Abstract: UTI is a significant cause of infection in VLBW infants. Urine culture should be included in all LOS evaluations in order to facilitate accurate diagnosis and appropriate antibiotic therapy.

Cited by 10 publications

References 21 publications

Meningitis, urinary tract, and bloodstream infections in very low birth weight infants enrolled in a heart rate characteristics monitoring trial

Meningitis, urinary tract, and bloodstream infections in very low birth weight infants enrolled in a heart rate characteristics monitoring trial

Urinary Tract Infection Epidemiology in NICUs in the United States

Urinary Tract Infections in Low Birth Weight Neonates

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