Nieto SA, Sotelo GJ, Mascareñas SAH, Castillo BJI, Salazar CL, De CDCC, Olivares RMJ

Language: Spanish
References: 19
Page: 22-26
PDF size: 198.46 Kb.

ABSTRACT

Introduction: In the Neonatal Intensive Care Unit (NICU), the risk of infection is related to the length of hospitalization and the immaturity of the immune system of newborns. Among healthcare-associated infections, urinary tract infections are the most frequent. Objective: To determine the diagnostic performance of the urine general examination (UGE) versus urine culture in UTI in newborns hospitalized in a neonatal intensive care unit (NICU). Material and methods: Observational and retrospective study. We included laboratory reports of consecutive newborns with clinical suspicion of UTI admitted in a NICU from January 2018 to June 2019. We recollected clinical urine tests and cultures parameters from the same sample and assessed the diagnostic yield of some of the urianalysis parameters associated to the presence of infection. We also reported some clinical manifestations presented by patients. Results: We included 172 patients with suspicion of UTI, 32 (18.6%) presented a positive urine culture. The gestational age of the positive urine culture group was lower, 33 ± 4.5 weeks of gestation (WG) vs 34.6 ± 3.6 WG in the negative urine culture patients (p = 0.034). The most common isolated bacteria were Klebsiella pneumoniae (31.5%), followed by Escherichia coli (26.5%). Failure to thrive was the most frequent clinical manifestation (p = 0.006). We did not find a sensibility higher than 50% in any individual or combined urianalysis parameter for positive urine cultures. We found a specificity of 95.7% for nitrites and 98.6% for yeast. Conclusions: We did not find a good diagnostic yield within individual or combined urianalysis parameters for positive urine cultures in the identification of urinary infections associated to health care in NICU newborn patients. We must consider failure to thrive as the most common clinical manifestation for urinary infections in this age group.

REFERENCES

1. Sastre JB, Aparicio AR, Cotallo GD, Colomer BF, Hernández MC. Urinary tract infection in the newborn: clinical and radio imaging studies. Pediatr Nephrol. 2007; 22: 1735-1741.

2. Bauer S, Eliakim A, Pomearnz A, Regev R, Litmanovits I, Arnon S et al. Urinary tract infection in very low birth weight preterm infants. Pediatr Infect Dis J. 2003; 22: 426-429.

3. Paschke AA, Zaoutis T, Conway PH, Xie D, Keren R. Previous antimicrobial exposure is associated with drug-resistant urinary tract infections in children, Pediatrics. 2010; 125 (4): 664-672.

4. Falcão MC. Urinary tract infection in full-term newborn infants: risk factor analysis, Rev Hosp Clin Fac Med S Paulo. 2000; 55 (1): 9-16.

5. Mohammed D, El Seifi O. Bacterial nosocomial infections in neonatal intensive care unit, Zagazig University Hospital, Egypt. Gaz Egypt Paediatr Assoc. 2014; 62: 72-79.

6. Movahedian AH, Mosayebi Z, Moniri R. Urinary tract infections in hospitalized newborns in Beheshti Hospital, Iran: a retrospective study. J Infect Dis Antimicrob Agents. 2007; 24 (1): 7-11.

7. García F, Nager A. Jaundice as an early sign of urinary tract infection in infancy. Pediatrics. 2002; 109 (5): 846-851.

8. Peralta RI, González CM, Pardo MR. Principales factores de riesgo asociados a infecciones nosocomiales de vías urinarias en un Servicio de Neonatología. Arch Inv Mat Inf. 2011; 3 (3): 138-144.

9. Vachharajani A, Vricella GJ, Najaf T, Coplen DE. Prevalence of upper urinary tract anomalies in hospitalized premature infants with urinary tract infection. J Perinatol. 2015; 35 (5): 362-366.

10. Kanellopoulos TA, Salakos C, Spiliopoulou I, Ellina A, Nikolakopoulou NM, Papanastasiou DA. First urinary tract infection in neonates, infants and young children: a comparative study. Pediatr Nephrol. 2006; 21: 1131-1137.

11. Ruangkit C, Satpute A, Vogt BA, Hoyen C, Viswanathan S. Incidence and risk factors of urinary tract infection in very low birth weight infants. J Neonatal Perinatal Med. 2016; 9 (1): 83-90.

12. Subcommittee on Urinary Tract Infection. Reaffirmation of AAP clinical practice guideline: the diagnosis and management of the initial urinary tract infection in febrile infants and young children 2-24 months of age. Pediatrics. 2016; 138 (6): e20163026.

13. Barton M, Bell Y, Thame M, Nicholson A, Trotman H. Urinary tract infection in neonates with serious bacterial infections admitted to the University Hospital of the West Indies. West Indian Med J. 2008; 57 (2): 101-105.

14. Arshad M, Seed PC. Urinary tract infections in the infant. Clin Perinatol. 2015; 42 (1): 17-28.

15. Arredondo GJ, Segura CE, Calderón JE, Mancilla RJ, Sánchez HG, Solórzano SF. Consenso mexicano en infecciones de vías urinarias en pediatría. Acta Pediatr Mex. 2007; 28 (6): 289-293.

16. Mohseny AB, van Velze V, Steggerda SJ, Smits-Wintjens VEHJ, Bekker V, Lopriore E. Late-onset sepsis due to urinary tract infection in very preterm neonates is not uncommon. Eur J Pediatr. 2018; 177 (1): 33-38.

17. Downey LC, Benjamin DK Jr, Clark RH, Watt KM, Hornik CP, Laughon MM et al. Urinary tract infection concordance with positive blood and cerebrospinal fluid cultures in the neonatal intensive care unit. J Perinatol. 2013; 33 (4): 302-306.

18. Rasool S, Mohsen E, Dariush S. Antimicrobial susceptibility pattern of extended-spectrum β-lactamase-producing bacteria causing nosocomial urinary tract infections in an Iranian referral teaching hospital. J Res Pharm Pract. 2014; 3 (1): 6-11.

19. Lai A, Rove K, Amin S, Vricella GJ, Coplen D. Diagnosis and management of urinary tract infections in premature and term infants. NeoReviews. 2018; 19 (6): e337-e348.