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Urinary tract infection concordance with positive blood and cerebrospinal fluid cultures in the neonatal intensive care unit

Journal of Perinatology volume 33, pages 302–306 (2013)Cite this article

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Abstract

Objective:

Urinary tract infections (UTI) are common in the neonatal intensive care unit (NICU). Blood, urine and cerebrospinal fluid (CSF) cultures are frequently obtained to evaluate for infection. We sought to determine the concordance between positive urine cultures and blood or CSF cultures.

Study Design:

Infants <121 days of age with a UTI admitted to 322 NICUs managed by the Pediatrix Medical Group from 1997 to 2010 were identified. UTIs were defined by isolation of a single pathogenic organism in a urine sample obtained by catheterization or suprapubic tap. The UTI was concordant if the same organism was identified in the blood or CSF within 3 days of the urine culture.

Result:

Of 5681 infants with a urine culture, 984 had 1162 UTIs. In total, 976 UTIs (84%) had a blood culture collected within 3 days, and 127 (13%) were concordant. Of the 1162 UTIs, 77 (7%) had a CSF culture collected within 3 days, and 2 (3%) were concordant.

Conclusion:

Collection of a urine culture in infants evaluated for late-onset sepsis is important. Concordance was observed in 13% of blood cultures and 3% of CSF cultures. These findings may be related to the initiation of empirical antimicrobial therapy before evaluation for disseminated infection or poor blood culture sensitivity.

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Acknowledgements

This study used CTSA biostatistical services through the Division of Pediatric Quantitative Sciences (NIH-5UL-1RR024128-01).

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Authors and Affiliations

  1. Department of Pediatrics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA

    L C Downey, D K Benjamin Jr, K M Watt, C P Hornik, M Cohen-Wolkowiez & P B Smith

  2. Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, USA

    R H Clark

  3. Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    M M Laughon

Authors
  1. L C Downey
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  2. D K Benjamin Jr
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  3. R H Clark
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  4. K M Watt
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  5. C P Hornik
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  6. M M Laughon
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  7. M Cohen-Wolkowiez
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  8. P B Smith
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Corresponding author

Correspondence to P B Smith.

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Competing interests

Dr Benjamin receives support from the United States government for his work in pediatric and neonatal clinical pharmacology (1R01HD057956-02, 1R01FD003519-01, 1U10-HD45962-06, 1K24HD058735-01 and Government contract HHSN267200700051C), from the non-profit organization Thrasher Research Foundation for his work in neonatal candidiasis (http://www.thrasherresearch.org) and from the industry for neonatal and pediatric drug development (http://www.dcri.duke.edu/research/coi.jsp). Dr Smith received support from the NICHD 1K23HD060040-01 and DHHS-1R18AE000028-01. Dr Downey received support from the T-32 Multidisciplinary Neonatal Training Grant (2T32 HD043728-06, PI Goldberg). Dr Watt received support from a T-32 Multidisciplinary Pediatric Training Grant (5T32HD043029-09, PI St Geme). Dr Cohen-Wolkowiez received support from the United States government for his work in pediatric and neonatal clinical pharmacology (Government contract HHSN267200700051C, PI Benjamin) and from the NICHD (1K23HD064814-01). No sponsoring agency had a role in the study design; collection, analysis and interpretation of the data; writing of the report; or the decision to submit the manuscript for publication. The remaining authors declare no conflict of interest.

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Downey, L., Benjamin, D., Clark, R. et al. Urinary tract infection concordance with positive blood and cerebrospinal fluid cultures in the neonatal intensive care unit. J Perinatol 33, 302–306 (2013). https://doi.org/10.1038/jp.2012.111

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