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. 2021 Jun;41(6):1474-1479.
doi: 10.1038/s41372-021-01079-6. Epub 2021 May 14.

Treatment of positive urine cultures in the neonatal intensive care unit: a guideline to reduce antibiotic utilization

Daniel P Gorski  1 , Adam S Bauer  1 , Nina S Menda  1 , Matthew W Harer  2
Affiliations

Treatment of positive urine cultures in the neonatal intensive care unit: a guideline to reduce antibiotic utilization

Daniel P Gorski et al. J Perinatol. 2021 Jun.

Abstract

Background: The pediatric definition of bacterial urinary tract infection (UTI) is >50,000 colony forming units (CFU) of a single organism on catheterized culture or 10,000-50,000 CFU with pyuria on urinalysis.

Local problem: The diagnosis of UTI in our NICU is clinician-dependent and not based on the accepted pediatric definition.

Methods: A retrospective review of positive urine cultures between 2015 and 2017 was performed.

Intervention: A treatment guideline for positive urine cultures was adopted and PDSA methodology utilized for incremental improvements.

Results: For 909 pre-intervention neonates, 26 of 38 positive urine cultures were treated for UTI but only 23% (6/26) met the pediatric definition. For 644 post-guideline neonates, only 7 of 25 positive urine cultures were treated and 86% met guideline criteria with no increase in urosepsis.

Conclusions: A guideline to treat positive urine cultures resulted in a decreased rate of UTI diagnosis and thus prevented unnecessary antibiotic exposure.

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