Neonatal Urinary Tract Infection Research Articles

Do Systemic Inflammatory Indices, Urinalysis, and Radiological Findings Vary by Causative Pathogen in Neonatal Urinary Tract Infections?

Urinary tract infections (UTI) are the most common occult infections in infants under three months of age with high fever, caused by various pathogens, and can progress with different symptoms from mild to severe. We planned to explore and compare pathogen-specific systemic inflammatory indices, urinalysis, and radiological findings in newborns. The retrospective study included preterm and term neonates with single pathogen growth of≥50.000 colony-forming units (CFU) /mL from urine cultures obtained by first-time catheterization between September 2019 and November 2021. Baseline hemogram parameters, acute phase reactants, systemic inflammatory indexes, urinalysis, and radiological findings were analyzed in pathogen-specific groups. Of the 132 patients included in the study, gastrointestinal symptoms were the most common. C-reactive protein values were higher in the non- E. Coli group (p<0.05). Procalcitonin values were higher in patients with Klebsiella spp. isolates (p<0.05). Systemic inflammatory indexes were higher in patients with Coagulase-Negative Staphylococci isolates (p<0.05). Urinary acidity was higher in the non-E. Coli group (p<0.05). Escherichia Coli and Klebsiella Spp. were isolated in two-thirds of patients with leukocyte esterase positivity. The most common cause of UTI in patients with abnormal renal ultrasound findings was E. Coli (33.3%). Our findings imply that unconventional tests could assist in pathogen differentiation, determining clinical presentation, and prognosis.

Clinical Profile Of Urinary Tract Infection In Neonates With Suspected Sepsis: Efficacy Of Dipstick Testing As A Diagnostic Tool

Clinical Profile Of Urinary Tract Infection In Neonates With Suspected Sepsis: Efficacy Of Dipstick Testing As A Diagnostic Tool

Risks of Renal Anomalies and Urinary Tract Infections in Neonates With Single Umbilical Artery.

Background Our study aims to evaluate the characteristics of congenital anomalies of kidneys and urinary tracts (CAKUT) and urinary tract infection (UTI) in babies with single umbilical artery (SUA) and to identify factors associated with these outcomes. Methods We performed a 15-year retrospective analysis on babies who were born ≥34 weeks with SUA between 2006 and 2020. Relevant clinical information on obstetrics and neonatal examinations, UTIs, and imaging of the urinary systems was evaluated. Results The frequency of SUA in newborns was 3.28 per 1,000 deliveries. The majority (271/291; 93.1%) of patients had kidney ultrasound, and 19 (7.0%) had CAKUT. Hydronephrosis (n = 11, 57.9%) was the commonest CAKUT, followed by unilateral kidney agenesis (n = 3, 15.8%), horseshoe kidney (n = 2, 10.5%), and right low-lying kidney (n = 2, 10.5%). Most significant CAKUT (including solitary kidney and urinary tract obstruction) could be detected during the antenatal period. Congenital heart defect (OR 4.93, 95% CI 1.59-15.34), limbs (OR 9.77, 95% CI 1.53-62.44), and sacral abnormalities (OR 5.06, 95% CI 1.25-20.55) were associated with CAKUT. Six (2.1%) developed UTIs during the study period, with the majority below two years old. The presence of CAKUT was associated with the development of UTI after adjustment (adjusted HR 10.28, 95% CI 1.86-56.83). Conclusions The overall prevalence of CAKUT was 7.0% in patients with SUA, and the majority of significant CAKUT was identified during the antenatal period. Congenital heart defects, limbs, and sacral abnormalities were associated with CAKUT. UTI occurred in 2.1% of patients.

Frequency and characteristics of seizures precipitated by febrile urinary tract infections in neonates and infants

BackgroundA febrile urinary tract infection (UTI) is a minor febrile seizure (FS) determinant. Seizures precipitated by febrile UTIs in neonates and infants frequently surprise parents, as they are vulnerable to bacterial meningitis and younger than the usual ages of FS. However, their frequency and characteristics are relatively unknown. MethodsThis study screened 1059 children (≤12 months) with febrile UTIs admitted to Chonnam National University Children's Hospital from January 2015 to June 2023. Patients with seizures precipitated by febrile UTIs were enrolled, and their medical records were reviewed. The frequency and clinical characteristics of seizures effectuated by febrile UTIs were investigated by comparing FS, FS+, and afebrile seizure (aFS). ResultsTwenty-eight patients (2.6%) were enrolled: 19 with early-onset FS+ (2.3% of 814 patients <6 months), nine with FS (3.7% of 245 patients), but there were none with aFS. Acute pyelonephritis was found in 80.8% of 26 patients. Clustered seizures (47.4% vs. 22.2% in FS, P = 0.197) and complex types (73.7% vs. 22.2%; P = 0.015) were frequent in early-onset FS+. Among 42 seizure episodes, bilateral tonic seizures were noted only in FS+ (44.8%; P = 0.001), but bilateral tonic-clonic seizures were frequent in FS (69.2% vs. 27.6%; P = 0.011). ConclusionSeizures precipitated by febrile UTIs occurred in 2.6% of neonates and infants: all were febrile and were predominantly with acute pyelonephritis. Infantile FS characteristics of febrile UTIs resembled those of usual FS, whereas early-onset FS + differed significantly as usually occurring in complex types and bilateral tonic ones.

Increased prevalence of non-E. coli bacteria-caused urinary infection in neonates delivered by cesarian section

to assess the association between delivery mode and causative pathogens of infants with urinary tract infections. We conducted a retrospective analysis of the medical records of neonates delivered in a tertiary academic pediatric hospital and diagnosed with urinary tract infections between January 1,2013 and December 31,2017. Excluded were newborns with urinary tract infections post-urological procedures or neurogenic bladders. The retrieved data included demographic characteristics, clinical presentations, laboratory findings, urine cultures, and renal imaging results. Multivariable logistic regressions were employed to identify associations. 95 of the 131 neonates' (72.5%) cultures were positive for Escherichia coli. Neonates born via cesarean section (C/S) had a significantly higher prevalence (12/25, 48%) of non-Escherichia coli infections (p=0.01). The mode of delivery was the only variable associated with non-Escherichia coli infections (odds ratio=3.1, p=0.014). Two of the 12 neonates (17%) with non-Escherichia coli cultures in the C/S group were diagnosed as having dilating vesicoureteral reflux. While the impact of mode of delivery on microbiome composition and UTI risk in the pediatric population is well documented, to the best of our knowledge, our study is the first to evaluate and report on the clinical connection between mode of delivery and neonatal UTIs. Most noteworthy was our finding of an elevated prevalence of non-E. coli cultures in the C/S group (p=0.014, OR 3.1). This bears important clinical implications, particularly in the setting of congenital anomaly of kidney and urinary tract (CAKUT) screening. Our analyses in this study reveal a significant link between delivery by cesarean section and neonatal urinary tract infections with non- Escherichia coli urine cultures. These findings carry implications for vesicoureteral reflux screening in neonates by raising the level of awareness of the association between the 2 factors. Additional prospective studies on larger cohorts are warranted to further elucidate this relationship and refine clinical decision-making in neonatal care.

Reducing IV Antibiotic Duration for Neonatal UTI Using a Clinical Standard Pathway.

Urinary tract infections (UTIs) are the most common bacterial infections in young infants and are traditionally treated with longer intravenous (IV) antibiotic courses. A growing body of evidence supports shorter IV antibiotic courses for young infants. Our primary aim was to decrease the IV antibiotic treatment to 3 days over 2 years for neonates aged 0 to 28 days who have been hospitalized with UTIs. Using quality improvement methods, our primary intervention was to implement a revised clinical pathway recommending 3 (previously 7) days of IV antibiotics. Our primary outcome measure was IV antibiotic duration, and the secondary outcomes were length of stay (LOS) and costs. The balancing measure was readmission within 30 days of discharge. Neonates were identified by using International Classification of Diseases diagnosis codes and excluded if they were admitted to the ICU or had a LOS >30 days. We used statistical process control to analyze outcome measures for 4 years before (baseline) and 2 years after the pathway revision (intervention) in February 2020. A total of 93 neonates were hospitalized with UTIs in the baseline period and 41 were hospitalized in the intervention period. We found special cause variation, with a significant decrease in mean IV antibiotic duration from 4.7 (baseline) to 3.1 days (intervention) and a decrease in mean LOS from 5.4 to 3.6 days. Costs did not differ between the baseline and intervention periods. There were 7 readmissions during the baseline period, and 0 during the intervention period. The implementation of a revised clinical pathway significantly reduced IV antibiotic treatment duration and hospital LOS for neonatal UTIs without an increase in hospital readmissions.

Yenidoğanlarda Uzamış Sarılıkta İdrar Yolu Enfeksiyonunun Sıklığı ve Rolü

Objective: The study aims to investigate the frequency and role of urinary tract infection (UTI) in prolonged jaundice in preterm and term neonates.&#x0D; Materials and Methods: This retrospective study occurred at Zeynep Kamil Maternity and Children's Hospital in Istanbul between January 2014 and April 2018. The study involved 391 neonates who presented to our outpatient clinics with prolonged jaundice. UTI was defined as urine culture growth of at least 10.000 colony-forming units per millilitre (CFU/ml) in samples obtained via urethral catheterization. Birth weight, sex, gestational age, chronological age, laboratory results, hospital courses of patients, ultrasound findings and phototherapy history were recorded. &#x0D; Results: UTI frequency was found to be 2.8% in 391 neonates with prolonged jaundice. Nine of them were male (81.8%), and 2 were female (18.2%). Eight patients with UTI (72.7%) were term and 3 (29.3%) were preterm. History of phototherapy, presence of leukocyturia or nitrituria, white blood cell count, and thrombocyte counts were significantly higher in the UTI group.&#x0D; Conclusion: Prolonged jaundice may be the first sign of UTI in neonates. Routine urine culture in neonates with prolonged jaundice may be useful, especially in those with a history of phototherapy and high white blood cell and thrombocyte counts.

Standardization of urinary tract infection diagnosis in the neonatal ICU: Experience at a tertiary care center.

Urinary tract infections (UTIs) and antibiotic overexposure are common neonatal problems. Recently, evidence has emerged that a standardized approach to neonatal UTI can reduce unnecessary diagnosis without complications. This quality improvement project aimed to achieve those goals in our neonatal intensive care unit (NICU). A UTI diagnosis guideline was adapted from the literature with the goal of maximizing the proportion of diagnosed UTIs that conform to accepted diagnostic criteria: >10,000 CFU/mL of one organism with pyuria, or >50,000 CFU/mL of one organism regardless of pyuria. The guideline was implemented in a level III NICU. Adherence, results, and complications were monitored for 12 months. Guideline adherence after implementation was favorable, as evidenced by increased adoption of urinalysis with microscopy. There was a non-significant increase in diagnostic adherence to criteria, 87% to 93%, and non-significant decrease in the rate of UTI diagnosis, 39% to 36%. Complications were not significantly changed. Most UTIs were due to gram-negative rods, especially E. coli; Enterococcus was a common contaminant. A guideline for diagnosing UTIs can safely increase uniformity. In contrast to previously published results, no significant changes were seen in the rate of UTI or the proportion of diagnoses conforming to the criteria for UTI. It is likely that guideline effects depend on the established practices of NICU providers. Additionally, a consistent pattern was seen in which organisms were more likely to be judged the source of true UTIs or contaminated cultures, meriting further study.

Analisis Faktor Resiko Sebagai Upaya Pencegahan terhadap Kejadian Kasus Infeksi Saluran Kemih

Urinary tract infection (UTI) is a collective term that describes infections involving any part of the urinary tract, namely the kidneys, ureters, bladder and urethra. UTIs can affect patients of all ages from newborns to adults and the elderly. In general, women experience UTI episodes more often than men, this is because women's urethra is shorter than men's. However, neonatal UTIs are more prevalent in male infants (2.7%) who do not undergo circumcision than female infants (0.7%). This research uses a literature study method through several national and international journals obtained from 31 reference sources through searches on PubMed, Science Direct, ResearchGate, and Google Scholar that have been published in the last 5 years. The results of the review show that there are several risk factors that can trigger UTIs such as age, type of abnormality, genetics, gender, behavioral factors, and catheter use. The discovery of several factors that play a role in the occurrence of UTIs. This is used to help patients to know what risk factors must be controlled so that they are more aware of the incidence of UTI cases.

Unraveling the epidemiology of urinary tract infections in neonates: Perspective from a Brazilian NICU

BackgroundUrinary tract infections (UTIs) can lead to neonatal complications like sepsis, worsened by empirical treatment, contributing to antimicrobial resistance (AMR). This study examined the incidence, etiology, risk factors, and antimicrobial susceptibility of uropathogens in a Neonatal Intensive Care Unit (NICU) in Brazil. MethodsMedical records of neonates hospitalized in the NICU from January 2015 to June 2022 were retrospectively analyzed through the National Healthcare Safety Network system. ResultsAmong 1,474 neonates, 3.9% developed UTI, with an alarming 24-fold increase in incidence from 2015 to 2021. Genitourinary complications (odds ratio = 4.8) were a major risk factor. Of the 71 uropathogens, 74.6% were Gram-negative bacteria (GNB), 21.2% Gram-positive bacteria (GPB), and 4.2% Candida albicans. AMR was notable, with 13.3% of GPB and 20.7% of GNB exhibiting multidrug-resistant (MDR), while 6.6% of GPB and 1.9% of GNB showed extensive drug-resistant (XDR). UTI was associated with prolonged hospitalization (16-59 days). In 57 neonates with UTI, 40.3% had bloodstream infections, elevating the risk of death (odds ratio = 1.8). ConclusionsThe study underscores the urgency of implementing infection prevention and control measures in the NICU to curb rising UTI incidences, combat AMR, and mitigate severe complications in critically ill neonates.

Concentration of novel urinary tract infection biomarkers in neonates

Urinary tract infections (UTIs) are a common comorbidity in hospitalized neonates. The current UTI diagnostics have several limitations including invasive collection of urinary samples to ensure sterility, risk of contamination and lack of consensus definitions of UTI based on urine culture. Antimicrobial peptides (AMPs) have been recently utilized as novel biomarkers that can efficiently and accurately diagnose pediatric UTI. However, the concentration of AMPs in neonatal urine is not well-defined. Urine from neonates admitted to a single level IV neonatal intensive care unit was obtained to determine baseline concentration of two AMPs, Ribonuclease 7 (RNase 7) and Beta Defensin-1 (BD-1) and to define the relationship between AMP concentration and gestational age (GA). AMP levels were normalized to urine creatinine. RNase 7 and BD-1 were expressed in neonatal urine (n = 66) regardless of GA and as early as 22 weeks gestation. Urinary concentrations of both AMPs decreased as GA and birthweight increased. The overall median urinary RNase 7/UCr and BD-1/UCr values were 271 ng/mg, and 116 ng/mg, respectively. Median urinary concentrations of RNase 7/UCr for infants born at < 27, 27–32, 33–35 and ≥ 36 weeks were 569, 308, 254, and 124 ng/mg respectively. Similarly, the concentrations of BD-1/UCr at these GA were 166, 115, 108, and 14 ng/mg, respectively. Baseline neonatal urinary concentration of two AMPs (RNase 7 and BD-1) and the variation by GA were identified. This is an essential first step toward the potential utilization of AMPs in improving neonatal UTI diagnostics.

Urinary tract dilation classification system for predicting surgical management and urinary tract infection in neonates and young infants: a systematic review and meta-analysis.

The urinary tract dilation classification system has recently been developed to ensure a unified approach to describe urinary tract dilation in neonates and young infants. However, the predictive value of this system for surgical intervention or urinary tract infection (UTI) has not yet been evaluated in a meta-analysis. This systematic review and meta-analysis aimed to evaluate the utility of a postnatal urinary tract dilation classification system for predicting surgical management or a UTI occurrence. As the urinary tract dilation classification system was introduced in 2014, we searched Embase and PubMed databases for studies published between January 2014 and December 2022. Original articles that reported surgical interventions or UTI episodes according to postnatal urinary tract dilation grades were included. The pooled odds ratio (OR) was calculated, using either the fixed-effects or random-effects model, given the lower urinary tract dilation grades as the base category. The quality of the included studies was evaluated using the Newcastle-Ottawa scale. Of the 285 articles reviewed, eight (comprising 2,165 children) were included in the analysis. The studies were of medium-to-high quality. Pooled analysis demonstrated that urinary tract dilation P3 (combined OR, 21.41; 95% confidence interval [CI], 15.72-29.17) and urinary tract dilation P2-P3 (combined OR, 65.17; 95% CI, 33.08-128.38) were associated with surgical intervention. The urinary tract dilation P3 (combined OR, 2.11; 95% CI, 1.56-2.85) and urinary tract dilation P2-P3 (combined OR, 3.36; 95% CI, 2.43-4.63) were associated with UTI episodes. The postnatal urinary tract dilation classification system is useful for predicting the need for surgical management and UTI episodes in infants with hydronephrosis.

Exploring the potential factors affecting the type of pathogens responsible for urinary tract infection in neonatal hyper bilirubinemia

Background: Unexplained neonatal hyperbilirubinemia may be the newborns’ sole clinical presentation of urinary tract infection (UTI). Objective: We aimed to determine the potential factors affecting the type of pathogens responsible for UTI in neonatal hyperbilirubinemia. Methods: This cross-sectional study retrospectively evaluated newborns admitted to the neonatal ward of Bandar Abbas Children’s hospital, between 2016 and 2018. Newborns with hyperbilirubinemia and culture-confirmed UTIs were included in the study. The following data were extracted from patients’ medical records: demographics and anthropometrics, type of delivery, newborn’s feeding, clinical manifestations, urine sampling method, and laboratory test results, including total bilirubin and urine culture. Results: Of the 96 neonates with hyperbilirubinemia and positive urine culture in this study, 63 (65.6%) were male. Their mean age was 13.60 ± 6.00 days. Escherichia coli (E. coli) was the most common pathogen isolated from the urine cultures (33.3%), followed by Klebsiella (24%). Age, sex, gestational age, birth weight, type of delivery, newborn’s feeding, clinical manifestations, total bilirubin levels, and urine sampling method were not associated with the type of pathogens isolated from urine culture (P&gt;0.05). Conclusions: Most urine cultures from newborns with hyperbilirubinemia were positive for E. coli. None of the potential factors evaluated in this study were correlated with the type of pathogens responsible for UTI in neonates with hyperbilirubinemia.

Clinical Features of Urinary Tract Infection in Neonates with Hyperbilirubinemia: A Cross-sectional Study

Introduction: Neonatal hyperbilirubinemia is a common physiological finding in neonates but sometimes Urinary Tract Infections (UTI) can occur in these neonates and it can be asymptomatic or may lead to complications. Many causative factors are listed out for development of neonatal jaundice but the UTI is less mentioned in previous studies. Aim: To study the prevalence of UTI and its clinical features in the neonates with hyperbilirubinemia. Materials and Methods: This cross-sectional study was conducted in Aakash Healthcare super specialty Hospital, Dwarka, New Delhi, India, between June 2019 and May 2020. Total 116 infants with neonatal hyperbilirubinemia were included in the study. The demographic features including date and time of admission, age at presentation of jaundice, mode of parturition, type of assistance for delivery (if any used), presence of cephalohaematoma, bruising or caput succedaneum, weight at birth, age at onset of jaundice (days of life), baby’s and mother’s blood group, any metabolic diseases in mother and father etc. were studied. A thorough haematological work-up was done and urine was collected in a sterile container by catheterisation. All samples were sent to the laboratory for microscopic analysis and culture. Data was statistically analysed using Mann-Whitney U-test and level of significant p-value was considered as less than 0.05. Results: A total of 116 cases of neonatal hyperbilirubinemia were included in this study. Out of the 116 cases, 66 cases (56.89%) were male neonates and infants and 50 cases (43.11%) were female neonates and infants. In this study, out of 116 neonates with hyperbilirubinemia, only 20 babies showed pus cells &gt;5 //hpf (high power field microscope) (suggesting UTI), out of the 20 babies, 08 babies showed culture negative and pus cells &gt;5 /hpf and remaining 12 babies showed culture positive and pus cells &gt;5 /hpf. Out of 12 cases of culture and sensitivity, 8 cases showed culture for Escherichia coli (E.coli) and remaining four cases, organism cultured was Klebsiella pneumonia. Conclusion: Hyperbilirubinemia may be the initial sign of UTI in neonates; it may be asymptomatic in jaundiced newborns. It is recommended that, evaluation of UTI should be made in cases of asymptomatic hyperbilirubinemia cases which helps the paediatrician for early detection and treatment of these affected newborns reducing the hospital stay and long term complications.

Urinary Tract Infections in Low Birth Weight Neonates.

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. 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. 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. 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. · UTIs occur often in preterm infants, especially boys.. · Education increases the performance of urine cultures.. · UTIs in preterm infants occur often without bacteremia..

Evaluation of urinary tract infections in neonatal indirect hyperbilirubinemia.

We have evaluated urinary tract infections (UTI) in neonatal indirect hyperbilirubinemia. Urine culture is not routinely requested in patients with indirect hyperbilirubinemia. However, debates continue about the frequency and investigation of UTI in neonatal indirect hyperbilirubinemia patients. The aim of this study was to determine the prevalence of UTI in neonates admitted to the hospital due to pathological indirect hyperbilirubinemia and whether a routine urine culture test is necessary in patients. In this retrospective study, we analyzed data from 1390 patients hospitalized to the Neonatal Unit due to pathological indirect hyperbilirubinemia. One hundred and eleven of these patients with detected bacterial agents in the urine cultures were evaluated. The type of the pathogens grown in urine culture, the number of colonies, and the antibiotic resistance status were evaluated. Among 1390 patients screened, 111 (8%) were found to have UTI, 68 of whom (61.3%) were male. Out of the microorganisms that grew, Escherichia coli was the dominant microorganism with 36.1%, which was followed by Klebsiella species (23.4%), and Enterococcus species (18%), respectively. The prevalence of UTI is high in the neonatal period as in all childhood and especially in patients admitted to the Neonatal Unit due to indirect hyperbilirubinemia. Escherichia coli and Klebsiella species are the most common bacterial agents that grow. Missing the diagnosis of urinary tract infection in neonates may cause renal problems. Therefore, we recommend requesting a urine culture in routine examinations of neonates who are diagnosed with pathological indirect hyperbilirubinemia and admitted to the hospital due to the need for phototherapy.

Prediction of Urinary Tract Infection in Neonates with Unexplained Indirect Hyperbilirubinemia

Background: Neonates with urinary tract infection (UTI) are susceptible to higher rates of morbidity and mortality, specifically when presented with hyperbilirubinemia. Screening for UTIs in jaundiced neonates is a cost-effective strategy. The aims of this study were to investigate the pattern of UTI (prevalence, etiology, and susceptible antimicrobial agents) in neonates admitted to the NICU with unexplained indirect hyperbilirubinemia, as well as to identify early predictors of UTI in order to reduce the present morbidity and long-term consequences in NICU patients.&#x0D; . Methods: A cross-sectional hospital-based study that included 140 neonates diagnosed with unexplained indirect hyperbilirubinemia in the first 4 weeks of life. A questionnaire was applied to obtain demographic and clinical data. A number of laboratory parameters were assessed with clinical examination. Bacterial growth of 1 × 103 colony-forming units/mL of a single uropathogen was used to identify the existence of UTI. Multivariate analysis was used to identify the predicting factors of UTIs. Results: In the NICU group investigated, 25.7% of subjects had a culture-proved UTI. The most frequently isolated organism was Escherichia coli. Amikacin was the most common antibiotic that the isolates were susceptible to. In multivariable logistic regression analysis, a positive urine culture was statistically associated with an increase in WBCs (OR= 6.90, p= 0.001), pyuria (OR= 5.55, p= 0.001), small for gestational age (OR= 4.07, p= 0.021), prolonged phototherapy duration (OR= 3.50, p= 0.034), and the presence of obstetric complications (OR= 2.92, p= 0.001). Conclusion: UTI is substantially prevalent among neonates admitted to the NICU with unexplained indirect hyperbilirubinemia. The importance of routine UTI screening (urine culture) as part of the clinical assessment of unexplained hyperbilirubinemia was highlighted in this study, particularly in neonates with leukocytosis, pyuria, small for gestational age, prolonged phototherapy, and those born from mothers with a history of obstetric complications.&#x0D;

Epidemiological, Clinical, and Diagnostic Aspects of Urinary Tract Infection in Newborns at the Departmental Teaching Hospital of Borgou-Alibori (DTH-B/A) in Benin

To study epidemiological and diagnostic aspects of urinary tract infection (UTI) in newborns at the Departmental Teaching Hospital of Borgou-Alibori (DTH-B/A). This was a cross-sectional study conducted from April 1, 2019 to September 30, 2019 and concerned all newborns admitted to the neonatal unit of DTH-B/A. According to the National Agency for Health Accreditation and Evaluation (NAHAE)recommendations of 2002, all symptomatic newborns who did not have a visible malformation outside the genitourinary system and whose parents gave their consent were included in the study. The census was exhaustive despite the calculated minimum size of 109 newborns. Urine sedimentation and cytobacteriological examination of urine samples, taken in adhesive bags after local disinfection, demonstrated presence of pathogenic microbes. Sensitivity of detected microbes was studied to different antibiotics. Interpretive reading of antibiograms was established according to the Standards of the French Society of Microbiology (FEMS), edition 2012. If UTI was confirmed, an abdominopelvic ultrasound was performed in search for a malformative uropathy as a contributing factor in newborns. A standardized survey was developed for data collection. The data entered were analyzed using the Epi info software, version 3.5.4. In all, 124 newborns were included in the study. UTI accounted for 8.06% of all neonatal infections and 2.15% of admissions. The average age of onset was 7.8 days, with a gender ratio of 1:1. The main clinical manifestations were jaundice and respiratory distress. Microbes involved were Staphylococcus aureus (6/10), Escherichia coli (2/10), and Klebsiella oxytoca (2/10). The resistance of microbes to antibiotics was generally high. No abnormalities were revealed in the ultrasound. Although neonatal UTI is not a rare infection, bacterial resistance is of concern.

Causative organisms and antimicrobial susceptibility in jaundiced infants with significant bacteriuria.

Jaundice may be one of the first signs of urinary tract infection (UTI) in infants. The most common pathogen is Escherichia coli. Currently recommended antibiotic treatment for neonatal UTI is ampicillin and an aminoglycoside. Recently, increasing ampicillin and gentamicin resistance in strains of E. coli has been isolated. The aim of this study was to determine causative organisms and antimicrobial susceptibility in jaundiced infants with significant bacteriuria (SB). We evaluated admitted afebrile, asymptomatic infants younger than 1-month old with hyperbilirubinemia (total bilirubin >15 mg/dl) requiring phototherapy between January 2011 and December 2015. A total of 615 asymptomatic jaundiced infants were enrolled. Urinalysis and urine cultures were performed on all jaundiced infants. A urine culture was defined as SB if a single pathogen with more than 105-colony forming units per milliliter (CFU/ml) by sterile urinary collection bag or 104 CFU/ml by catheterization was isolated. A total of 88 (14.3%) of 615 asymptomatic jaundiced infants had positive urinary culture. E coli was the most common cultured bacteria (40 cases, [45.5%]). Enterococcus faecalis was the second most common bacteria (17 cases, [19.3%]). Seven cases (8.0%) of Streptococcus agalactiae and six cases (6.8%) of Klebsiella pneumoniae were also identified. Ampicillin sensitivity was found in 22.5% of E. coli infections, gentamicin sensitivity was found in 84.2%, and extended-spectrum β-lactamases were found in 7.5%. E. coli was the most common causative organism for infants with SB. We suggest modifying current empiric antibiotics by changing gentamicin to amikacin for neonatal Gram-negative bacterial infections.

Proportion of urinary tract infection in neonatal sepsis

Background: Urinary tract infection (UTI) in neonates might be associated with bacteremia and congenital anomalies of the kidney and urinary tract (CAKUT), that in complicated situations can lead to renal parenchymal scarring and chronic kidney disease. Aim: To determine occurrence of UTI in neonatal sepsis. Methods: This cross sectional study was conducted on 500 term, extramural hospitalized neonates, suspected to have infection underwent, a detailed history, physical examination and a comprehensive sepsis workup. The diagnosis of neonatal UTI was based, on positive urine culture, obtained by suprapubic aspiration (SPA). Results: Out of 500 neonates included in our study (324 boys and 176 girls), blood culture was positive in 84 (36.5%) neonates in early-onset sepsis group (n=230), while in late-onset sepsis group (n=270) blood culture was positive in130 (48.1%), p-value < 0.05. In both early-onset sepsis (EOS) and late-onset sepsis (LOS) groups, blood culture was found to be positive in a greater proportion of male (41.3%) than female (29.3%) patients, p-value <0.05. The most common organism isolated from blood and urine culture was Klebsiella, followed by E-coli. Urine culture was positive in 34 (6.8%) patients, among whom 29 (85%) culture-positive cases were from the LOS group, a p-value of <0.05. Conclusions: UTI is not uncommon among the hospitalized neonates, and UTI evaluation among septic neonates can prove beneficial for the prevention of long-term sequelae of neonatal UTI.