Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Urinary tract infection is common in VLBW infants

Abstract

Objective

Determine the significance of urinary tract infection (UTI) as a cause of late onset sepsis (LOS) in very low birth weight (VLBW) infants in the Neonatal Intensive Care Unit (NICU).

Study design

Analysis of blood, cerebrospinal fluid and urine culture results in VLBW infants >72-h old, admitted to the Georgetown University Hospital NICU between 2005 and 2015.

Result

Of 527 VLBW infants, 297 (56.4%) underwent 911 evaluations for LOS; only one-third included urine cultures. UTI was diagnosed in 8.5% of VLBW infants (range 2–15.9%) and in 13.8% of infants weighing < 1000 g at birth. Gram-negative infections predominated. Concomitant blood cultures were negative in 96% of infants. UTI was more common than bloodstream infection by 2015.

Conclusion

UTI is a significant cause of infection in VLBW infants. Urine culture should be included in all LOS evaluations in order to facilitate accurate diagnosis and appropriate antibiotic therapy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Shah DK, Doyle LW, Anderson PJ, Bear M, Daley AJ, Hunt RW, et al. Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term. J Pediatr. 2008;153:170–5.

    Article  Google Scholar 

  2. Mitha A, Foix-L ‘Hélias L, Arnuad C, Marret S, Vieux R, Aujard Y, et al. Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants. Pediatrics. 2013;132:e372–80.

    Article  Google Scholar 

  3. Schlapbach LJ, Aebischer M, Adams M, Natalucci G, Bonhoeffer J, et al. Impact of sepsis on neurodevelopmental outcome in a Swiss National Cohort of extremely premature infants. Pediatrics. 2011;128:e348–57.

    Article  Google Scholar 

  4. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenhranz RA, et al. Late onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002;110(2 Pt 1):285–91.

    Article  Google Scholar 

  5. Boghossian ND, Page GP, Bell EF, Stoll BJ, Murray JC, Cotton CM, et al. Late-onset sepsis in very low birth weight infants from singleton and multiple-gestation births. J Pediatr. 2013;162:1120–4.

    Article  Google Scholar 

  6. Bowen JR, Callander I, Richards R, Lindrea KB. Decreasing infection in neonatal intensive care units through quality improvement. Arch Dis Child Fetal Neonatal Ed. 2017;102:F51–7.

    Article  CAS  Google Scholar 

  7. Fisher D, Cochran KM, Provost LP, Patterson J, Bristol T, Metzquer K, et al. Reducing central-line associated bloodstream infections in North Carolina NICUs. Pediatrics. 2013;132:e1664–71.

    Article  Google Scholar 

  8. Almeida CC, Pissarra da Silva SMS, Flor de Lima Caldas de Oliveira FSD, Guimarães Pereira Areias MHF. Nosocomial sepsis: evaluation of the efficacy of preventive measures in a level-III neonatal intensive care unit. J Matern Fetal Neonatal Med. 2017;30:2036–41.

    Article  Google Scholar 

  9. Bizzarro MJ, Shabanova V, Baltimore RS, Dembry LM, Ehrenkranz RA, et al. Neonatal sepsis 2004-2013: the rise and fall of coagulase-negative staphylococci. J Pediatr. 2015;166:1193–999.

    Article  Google Scholar 

  10. Bauer S, Eliakim A, Pomeranz A, Regev R, Litmanovits I, Amon S, et al. Urinary tract infection in very low birth weight preterm infants. Pediatr Infect Dis J. 2003;22:426–30.

    PubMed  Google Scholar 

  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 Perinat Med. 2016;9:83–90.

    Article  CAS  Google Scholar 

  12. 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.

    Article  Google Scholar 

  13. Mohseny AB, van Velze V, Steggerda SJ, Smits-Wintjens VEHJ, Bekker V, Lopriote E. Late-onset sepsis due to urinary tract infection in very preterm neonates is not uncommon. Eur J Pediatr. 2018;177:33–8.

    Article  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. Weems MF, Wei D, Ramanathan R, Barton L, Vachon L, Sardesai S. Urinary tract infections in a neonatal intensive care unit. Am J Perinatol. 2015;32:695–702.

    PubMed  Google Scholar 

  16. Foglia EE, Lorch SA. Clinical predictors of urinary tract infection in the neonatal intensive care unit. J Neonatal Perinat Med. 2012;5:327–33.

    CAS  Google Scholar 

  17. Tamim MM, Alesseh H, Aziz H. Analysis of the efficacy of urine culture as part of sepsis evaluation in the premature infant. Pediatr Infect Dis J. 2003;22:805–8.

    Article  Google Scholar 

  18. Sastre JB, Aparicio AR, Cotallo GD, Colomer BF, Hernández MC. Grupo de Hospitales Castrillo. Urinary tract infection in the newborn: clinical and radio imaging studies. Pediatr Nephrol. 2007;22:1735–41.

    Article  Google Scholar 

  19. Roberts KB. Subcommittee of urinary tract infection. Steering Committee on Quality Improvement and Management: urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128:595–610.

    Article  Google Scholar 

  20. Cotton CM. Adverse consequences of neonatal antibiotic exposure. Curr Opin Pediatr. 2016;28:141–9.

    Article  Google Scholar 

  21. Carr D, Barnes EH, Gordon A, Isaacs D. Effect of antibiotic use on antimicrobial antibiotic resistance and late-onset neonatal infections over 25 years in an Australian tertiary neonatal unit. Arch Dis Child Fetal Neonatal Ed. 2017;102:F244–50.

    Article  Google Scholar 

  22. Cantey JB, Wozniak PS, Sánchez PJ. Prospective surveillance of antibiotic use in the neonatal intensive care unit: results from the SCOUT study. Pediatr Infect Dis J. 2015;34:267–72.

    Article  Google Scholar 

  23. Jacqz-Aigrain E, Zhao W, Sharland M, van den Anker JN. Use of antibacterial agents in the neonate: 50 years of experience with vancomycin administration. Semin Fetal Neonatal Med. 2013;18:28–34.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Caitlin M. Drumm.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Drumm, C.M., Siddiqui, J.N., Desale, S. et al. Urinary tract infection is common in VLBW infants. J Perinatol 39, 80–85 (2019). https://doi.org/10.1038/s41372-018-0226-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-018-0226-4

This article is cited by

Search

Quick links