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Am J Perinatol 2024; 41(S 01): e2202-e2208
DOI: 10.1055/s-0043-1771015
Original Article

Urinary Tract Infection Epidemiology in NICUs in the United States

Ryan Kilpatrick 
1   Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
2   Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
,
Angelique E. Boutzoukas
1   Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
2   Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
,
Elizabeth Chan    *
2   Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
,
Valerie Girgis   *
2   Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
,
Vincent Kinduelo   *
2   Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
,
Sarah Ama Kwabia   *
2   Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
,
Jenny Yan   *
2   Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
,
Reese H. Clark 
3   Center for Research, Education, Quality, and Safety, Pediatrix Medical Group, Inc, Sunrise, Florida
,
Kanecia O. Zimmerman
1   Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
2   Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
,
Rachel G. Greenberg 
1   Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
2   Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
› Author Affiliations
Funding This work was funded under the National Institute of Child Health and Human Development (NICHD) contract (identifier: HHSN275201 000003I) for the Pediatric Trials Network (PI Daniel K. Benjamin Jr.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was also supported by Duke Clinical Research Institute's R25 Summer Training in Academic Research (STAR) Program (grant no.: 5R25HD076475-09), U.S. Department of Health and Human Services.
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Abstract

Objective Our objective was to characterize the incidence, associated clinical factors, timing of infection, microbiology, and incidence of concordant blood culture of urinary tract infections (UTIs) in very low birth weight (VLBW <1,500g) infants.

Study Design Multicenter observational cohort study of VLBW infants with gestational age (GA) ≤32 weeks, still hospitalized on postnatal day 7, and discharged 2010 to 2018 from Pediatrix Medical Group neonatal intensive care units. Demographic and clinical characteristics of infants with and without UTI were compared. Multivariable logistic regression evaluated adjusted odds of UTI diagnosis.

Results Of 86,492 included infants, 5,988 (7%) had a UTI. The most common pathogen was Enterococcus spp. (20%), followed by Escherichia coli (19%) and Klebsiella spp. (18%). Candida spp. (6%) was the most common nonbacterial pathogen. Concordant-positive blood culture was present in 8% of infants with UTI diagnoses. UTI was associated with lower GA, male sex, vaginal delivery, prenatal steroid exposure, and longer duration of hospitalization.

Conclusion UTI is a common cause of infection in VLBW infants, especially among the smallest, most premature, male infants, and those with a longer duration of hospitalization. Neonatal clinicians should consider obtaining urine culture in the setting of late-onset sepsis evaluations in VLBW infants.

Key Points

  • UTI is a common cause of LOS in VLBW infants.

  • The most common pathogens are Enterococcus spp. and E. coli.

  • UTI risk varies among different VLBW infant populations.

  • Next steps should include evaluation of preventative measures.

Keywords

very low birth weight infants - urinary tract infection - small for gestational age - concordant blood culture

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


Authors' Contributions

Dr. Greenberg contributed to the conception and design of the study, supervised the drafting of the manuscript, interpreted the data analyses, and reviewed and revised the manuscript. Dr. Greenberg had full access to all the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.

R.K. conceptualized and designed the study and contributed to the data interpretation, the drafting of the initial manuscript, and reviewing and revising the manuscript.

A.E.B. contributed to the data interpretation and the critical revision of the manuscript for important intellectual content.

E.C. contributed to the data interpretation and the manuscript drafting.

V.G. contributed to the data interpretation and the manuscript drafting.

V.K. contributed to the data interpretation and the manuscript drafting.

S.A.K. contributed to the data interpretation and the manuscript drafting.

J.Y. contributed to the data interpretation and the manuscript drafting.

R.H.C. contributed to the data interpretation and the critical revision of the manuscript for important intellectual content.

K.O.Z. contributed to the data interpretation and the critical revision of the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


* High school or college student affiliated with the Duke Clinical Research Institute's R25 Summer Training in Academic Research (STAR) Program.


Supplementary Material



Publication History

Received: 10 November 2022

Accepted: 01 June 2023

Article published online:
10 July 2023

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