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Observational Study
. 2024 May;41(S 01):e2202-e2208.
doi: 10.1055/s-0043-1771015. Epub 2023 Jul 10.

Urinary Tract Infection Epidemiology in NICUs in the United States

Ryan Kilpatrick  1   2 , Angelique E Boutzoukas  1   2 , Elizabeth Chan  2 , Valerie Girgis  2 , Vincent Kinduelo  2 , Sarah Ama Kwabia  2 , Jenny Yan  2 , Reese H Clark  3 , Kanecia O Zimmerman  1   2 , Rachel G Greenberg  1   2
Affiliations
Observational Study

Urinary Tract Infection Epidemiology in NICUs in the United States

Ryan Kilpatrick et al. Am J Perinatol. 2024 May.

Abstract

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: · UTI is a common cause of LOS in VLBW infants.. · The most common pathogens are Enterococcus spp. and E. coli.. · UTI risk varies among different VLBW infant populations.. · Next steps should include evaluation of preventative measures..

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Conflict of interest statement

R.G.G. has received support from the industry for research services ( https://dcri.org/about-us/conflict-of-interest/ ).

Figures

Figure 1.
Figure 1.. Flow Diagram
This figure displays a flow diagram of the initial study population, exclusions, and the final number of infants included in the analysis. ELBW = extremely low birth weight; NICU = neonatal intensive care unit; UTI = urinary tract infection; VLBW = very low birth weight
Figure 2.
Figure 2.. Postnatal Day of First Positive Urine Culture
This figure displays the percentage of infants with first positive urine culture on which postnatal day. Positive urine cultures were most common in infants postnatal age 8–30 days.
See this image and copyright information in PMC

References

    1. 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;177:33–8. - PMC - PubMed
    1. Clarke D, Gowrishankar M, Etches P, Lee BE, Robinson JL. Management and outcome of positive urine cultures in a neonatal intensive care unit. J Infect Public Health. 2010;3:152–8. - PubMed
    1. Griffin MP, Lake DE, Bissonette EA, Harrell FE Jr., O’Shea TM, Moorman JR. Heart rate characteristics: novel physiomarkers to predict neonatal infection and death. Pediatrics. 2005;116:1070–4. - PubMed
    1. Levy I, Comarsca J, Davidovits M, Klinger G, Sirota L, Linder N. Urinary tract infection in preterm infants: the protective role of breastfeeding. Pediatr Nephrol. 2009;24:527–31. - PubMed
    1. Downey LC, Benjamin DK Jr., Clark RH, et al. Urinary tract infection concordance with positive blood and cerebrospinal fluid cultures in the neonatal intensive care unit. J Perinatol. 2013;33:302–6. - PMC - PubMed

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