Neonatal Urinary Tract Infection: Clinical Response to Empirical Therapy versus In vitro Susceptibility at Bahrami Children’s Hospital- Neonatal Ward: 2001-2010
Urinary tract infection (UTI) is a neonatal life threatening infection which is usually treated with ampicillin plus an aminoglycoside or a third-generation cephalosporin. Recently, growing number of Escherchia coli species resistant to ampicillin and aminoglycosides have raised concerns regarding the necessity to change the empirical therapy. This motivates us to determine neonatal UTI clinical response to the used empirical antibiotics. This study was designed as a Case Series. All neonates admitted to Bahrami Children Hospital, Tehran, Iran, during 2001- 2010 with a diagnosis of UTI surveyed by simple non-random sampling. Totally, 97 cases (including 83 (85.6%) term, 8 (8.2%) post-term and 6 (6.2%) preterm neonates) with a mean age of 15.85 ± 7.05 days at admission ,average weight of 3195.57 ± 553g at birth and 3276.29 ± 599.182 g at admission were studied. Ampicillin resistance in 93 cases (95.9%), gentamicin resistance in 51 cases (52.6%) and trimethoprim- sulfamethoxazole resistance in 44 cases (45.4%) were the leading resistances in this study. Escherichia coli was the dominant organism in 76.3% (74 patients) of study population which was resistant to ampicillin in 95.9% (71 cases). Despite the observed resistant to initial empirical regimen antibiotics (especially ampicillin), 81.4% of patients responded to empirical therapy. However, we believe till conductance of more detailed studies regarding the relationship between empirical therapy and antibiogram concordance, physicians take ampicillin-resistant E coli infection issue into accounts from the first steps of management of critically ill neonates.
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(10):1735-41.
Edwards MS. Postnatal bacterial infection. In: Martin RJ, Fanaroff. AA, Walsh MC, editors. Fanaroff and Martin's Neonatal-Perinatal. Medicine: Diseases of the Fetus and Infant. 9th ed. Philadelphia, PA: Elsevier Mosby; 2011. p. 816.
Eliakim A, Dolfin T, Korzets Z, Wolach B, Pomeranz A. Urinary tract infection in premature infants: the role of imaging studies and prophylactic therapy. J Perinatol 1997;17(4):305-8.
Garcia FJ, Nager AL. Jaundice as an early diagnostic sign of urinary tract infection in infancy. Pediatrics 2002;109(5):846-51.
Khalesi N, Sharaky T, Haghighe M. Prevalence of urinary tract infection in neonates with prolonged jaundice referred to Aliasghar Hospital in Zahedan (2005). J Qazvin Univ Med Sci (JQUMS) 2007;11(3):14-8.
Schnadower D, Kuppermann N, Macias CG, Freedman SB, Baskin MN, Ishimine P, Scribner C, Okada P, Beach H, Bulloch B, Agrawal D, Saunders M, Sutherland DM, Blackstone MM, Sarnaik A, et al; American Academy of Pediatrics Pediatric Emergency Medicine Collaborative Research Committee. Febrile infants with urinary tract infections at very low risk for adverse events and bacteremia. Pediatrics 2010;126(6):1074-83.
American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999;103(4 Pt 1):843-52. Erratum in: Pediatrics 1999;103(5 Pt 1):1052, 1999;104(1 Pt 1):118. 2000;105(1 Pt 1):141.
Pappas PG. Laboratory in the diagnosis and management of urinary tract infections. Med Clin North Am 1991;75(2):313-25.
Byington CL, Rittichier KK, Bassett KE, Castillo H, Glasgow TS, Daly J, Pavia AT. Serious bacterial infections in febrile infants younger than 90 days of age: the importance of ampicillin-resistant pathogens. Pediatrics 2003;111(5 Pt 1):964-8.
Zorc JJ, Levine DA, Platt SL, Dayan PS, Macias CG, Krief W, Schor J, Bank D, Shaw KN, Kuppermann N; Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics 2005;116(3):644-8.
Shaw KN, McGowan KL, Gorelick MH, Schwartz JS. Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatrics 1998;101(6):1-5.
Feld LG, Greenfield SP, Ogra PL. Urinary tract infections in infants and children. Pediatr Rev 1989;11(3):71-7.
Nafday SM, Satlin LM, Benchimol C, Brion LP, Edelmann CM. Renal disease. In: MacDonald MG, Seshia MMK, Mullett MD, editors. Avery's Neonatology. 6th ed. Philadelphia, PA; Lippincott Williams and Wilkins; 2005. p. 2071-7.
Maherzi M, Guignard JP, Torrado A. Urinary tract infection in high-risk newborn infants. Pediatrics 1978;62(4):521-3.
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.
Joseph TA, Pyati SP, Jacobs N. Neonatal early-onset Escherichia coli disease. The effect of intrapartumampicillin. Arch Pediatr Adolesc Med 1998;152(1):35-40.
Towers CV, Carr MH, Padilla G, Asrat T. Potential consequences of widespread antepartal use of ampicillin.Am J Obstet Gynecol 1998;179(4):879-83.
Allen UD, MacDonald N, Fuite L, Chan F, Stephens D. Risk factors for resistance to "first-line" antimicrobialsamong urinary tract isolates of Escherichia coli in children. CMAJ 1999;160(10):1436-40.
Saffar MJ, Enayti AA, Abdolla IA, Razai MS, Saffar H. Antibacterial susceptibility of uropathogens in 3 hospitals,Sari, Islamic Republic of Iran, 2002-2003. East Mediterr Health J 2008;14(3):556-63.
Stoll BJ. Infections of neonatal infant. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011. p. 629-48.
Sobel JD, Kaye D. Urinary tract infections. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2005. p. 875-900.
Stamm WE. Urinary tract infections, pyelonephritis, and prostatitis. In: Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw-Hill; 2008. p. 1820-7.