Urinary Tract Infections in Low Birth Weight Neonates

Abstract

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

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

“…This cohort of infants had a 6.4% overall incidence of urinary tract infections, and, interestingly, 78% were BPT infants. Studies suggest a urine culture should be part of workups to evaluate preterms for LOS [ 47 ]. Because we did not collect decision data, there is no way of knowing how a decision to obtain a urine culture was made when an infant was showing signs and symptoms of sepsis.…”

Pathogen-specific alterations in intestinal microbiota precede urinary tract infections in preterm infants: a longitudinal case-control study

“…UTI is one of the most common infections in preterm infants in NICUs, presenting a high incidence around the world. 2 , 3 , 39–41 In our center, urine cultures were routinely performed through catheterization when infants present with nonspecific manifestations associated with infection, especially among those at more than one week of age, and a relatively high incidence of UTI was yielded. Similar to other preterm infant populations, 2–4 , 40 , 41 the pathogen spectrum of UTIs in this study was dominated by the Enterobacteriaceae family, including pathogenic organisms Klebsiella and Escherichia .…”

“…Historically, an overarching perspective concerning UTIs in preterm infants emphasized the bloodstream as the origin of UTI pathogens. 2 , 3 , 7 However, in light of the increasing emphasis on the gut as a repository of UTI pathogens in other populations 8–11 , 35 and the unfavorable intestinal microbial features of preterm infants, 13 , 14 , 16 we investigated the relationship between gut microbiota and UTIs in preterm infants. Through longitudinal observation, our results revealed that UTI infants with different pathogens exhibited distinct microbial development trajectory.…”