Neonatal Urinary Tract Infection in a Tertiary Care Center in Amman, Jordan

Document Type: Original Article

Authors

Department of Pediatrics, School of Medicine, The University of Jordan, Amman, Jordan

Abstract

Background: The aim of this study was to describe the prevalence of neonatal urinary tract infection (UTI), demographics, and clinical characteristics in a single referral tertiary neonatal intensive care unit.
Methods: The medical records of 118 neonates diagnosed with neonatal UTI were reviewed over a 7-year period.
Results: The prevalence of neonatal UTI was 1.5%. The male to female ratio was 1.6:1. In this study, 61% of the neonates were preterm babies. The mean age of diagnosis was 19.55±19.5 days. Pyuria was observed in 20% of the cases, and Escherichia coli was the most common pathogen. Hospital-acquired UTI was observed in 76% of the cases, and community-acquired UTI was noticed in 24% of the subjects. Prolonged jaundice was the most common presenting symptom of UTI followed by sepsis. An abnormal ultrasound was found in 29% of the neonates with hydronephrosis as the most associated anomaly. There was a high rate of extended spectrum-beta lactamase organisms and a high rate of antimicrobial resistance.
Conclusion: The occurrence of neonatal UTI was rare in the study population. In addition, hydronephrosis was the most common anomaly. Proper antibiotic stewardship is needed to halt the increasing antimicrobial resistance of uropathogens.

Keywords


1. Bauer S, Eliakim A, Pomeranz A, Regev R, Litmanovits I, Arnon S, et al. Urinary tract infection in very low birth weight preterm infants. Pediatr Infect Dis J. 2003; 22(5):426-30.
2. Sastre JBL, 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(10):1735-41.
3. Lai A, Rove KO, Amin S, Vricella GJ, Coplen DE. Diagnosis and management of urinary tract infections in premature and term infants. NeoReviews. 2018; 19(6):e337-48.
4. Zorc JJ, Levine DA, Platt SL, Dayan PS, Macias CG, Krief W, et al. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics. 2005; 116(3):644-8.
5. Bonadio W, Maida G. Urinary tract infection in outpatient febrile infants younger than 30 days of age: a 10-year evaluation. Pediatr Infect Dis J. 2014; 33(4):342-4.
6. Alizadeh Taheri P, Navabi B, Shariat M. Neonatal urinary tract infection: clinical response to empirical therapy versus in vitro susceptibility at Bahrami Children’s Hospital- Neonatal Ward: 2001-2010. Acta Med Iran. 2012; 50(5):348-52.
7. Friedman S, Shah V, Ohlsson A, Matlow AG. Neonatal escherichia coli infections: concerns regarding resistance to current therapy. Acta Paediatr. 2000; 89(6):686-9.
8. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. 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(3):595-610.
9. Vachharajani A, Vricella GJ, Najaf T, Coplen DE. Prevalence of upper urinary tract anomalies in hospitalized premature infants with urinary tract infection. J Perinatol. 2015; 35(5):362-6.
10. Biyikli NK, Alpay H, Ozek E, Akman I, Bilgen H. Neonatal urinary tract infections: analysis of the patients and recurrences. Pediatr Int. 2004; 46(1):21-5.
11. 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(7):695-702.
12. Ismaili K, Lolin K, Damry N, Alexander M, Lepage P, Hall M. Febrile urinary tract infections in 0- to 3-month-old infants: a prospective follow-up study. J Pediatr. 2011; 158(1):91-4.
13. Kanellopoulos TA, Salakos C, Spiliopoulou I, Ellina A, Nikolakopoulou NM, Papanastasiou DA. First urinary tract infection in neonates, infants and young children: a comparative study. Pediatr Nephrol. 2006; 21(8):1131-7.
14. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008; 27(4):302-8.
15. Han YJ, Yu SL, Tao YZ. Urinary tract infections in the neonatal intensive care unit: clinical analysis of 229 cases. Zhongguo Dang Dai Er Ke Za Zhi. 2012; 14(3):177-80.
16. Youssef DM, Elfateh HA, Sedeek R, Seleem S. Epidemiology of urinary tract infection in neonatal intensive care unit: a single center study in Egypt. J Acad Med Sci. 2012; 2(1):25-9.

17. Tola HH, Ranjbaran M, Omani-Samani R, Sadeghi M. Prevalence of UTI among Iranian infants with prolonged jaundice, and its main causes: a systematic review and meta-analysis study. J Pediatr Urol. 2018; 14(2):108-15.
18. Özcan M, Sarici SÜ, Yurdugül Y, Akpinar M, Altun D, Özcan B, et al. Association between early idiopathic neonatal jaundice and urinary tract infections. Pediatrics. 2017; 11:1179556517701118.
19. Mohseny AB, van Velze V, Steggerda SJ, Smits-Wintjens VE, Bekker V, Lopriore E. Late-onset sepsis due to urinary tract infection in very preterm neonates is not uncommon. Eur J Pediatr. 2018; 177(1):33-8.
20. 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(9):805-8.
21. Cleper R, Krause I, Eisenstein B, Davidovits M. Prevalence of vesicoureteral reflux in neonatal urinary tract infection. Clin Pediatr (Phila). 2004; 43(7):619-25.
22. Asghar AM, Leong T, Cooper CS, Arlen AM. Hospital-acquired urinary tract infections in neonatal ICU patients: is voiding cystourethrogram necessary? Urology. 2017; 105:163-6.
23. 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(3):527-31.
24. Foglia EE, Lorch SA. Clinical predictors of urinary tract infection in the neonatal intensive care unit. J Neonatal Perinat Med. 2012; 5(4):327-33.
25. Badran EF, Din RA, Shehabi AA. Low intestinal colonization of Escherichia coli clone ST131 producing CTX-M-15 in Jordanian infants. J Med Microbiol. 2016; 65(2):137-41.
26. Fan NC, Chen HH, Chen CL, Ou LS, Lin TY, Tsai MH, et al. Rise of community-onset urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli in children. J Microbiol Immunol Infect. 2014; 47(5):399-405.
27. Flokas ME, Detsis M, Alevizakos M, Mylonakis E. Prevalence of ESBL-producing Enterobacteriaceae in paediatric urinary tract infections: a systematic review and meta-analysis. J Infect. 2016; 73(6): 547-57.
28. Flannery DD, Brandsma E, Saslow J, Mackley AB, Paul DA, Aghai ZH. Do infants in the neonatal intensive care unit diagnosed with urinary tract infection need a routine voiding cystourethrogram? J Matern Fetal Neonatal Med. 2017; 32(11):1749-54.
29. Nowell L, Moran C, Smith PB, Seed P, Alexander BD, Cotten CM, et al. Prevalence of renal anomalies after urinary tract infections in hospitalized infants less than 2 months of age. J Perinatol. 2010; 30(4):281-5.
30. Pauchard JY, Chehade H, Kies CZ, Girardin E, Cachat F, Gehri M. Avoidance of voiding cystourethrography in infants younger than 3 months with Escherichia coli urinary tract infection and normal renal ultrasound. Arch Dis Child. 2017; 102(9):804-8.
31. Hasvold J, Bradford L, Nelson C, Harrison C, Attar M, Stillwell T. Gentamicin resistance among Escherichia coli strains isolated in neonatal sepsis. J Neonatal Perinatal Med. 2013; 6(2):173-7.