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

Abstract

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. The diagnosis of UTI in our NICU is clinician-dependent and not based on the accepted pediatric definition. A retrospective review of positive urine cultures between 2015 and 2017 was performed. A treatment guideline for positive urine cultures was adopted and PDSA methodology utilized for incremental improvements. 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. A guideline to treat positive urine cultures resulted in a decreased rate of UTI diagnosis and thus prevented unnecessary antibiotic exposure.