Management and outcome of positive urine cultures in a neonatal intensive care unit

The aim of this study was to describe the management and outcome of positive urine cultures in a neonatal intensive care unit [NICU]. A chart review was completed of infants born October 1, 2004 to December 31, 2006 and admitted to the NICU at the Royal Alexandra Hospital, Edmonton, Alberta with any growth of bacteria or fungi in urine. Positive urine cultures were obtained in 64 of 2936 admissions [2%] and were classified as contaminated urines [n=34], possible urinary tract infection [UTI] [n=14], definite UTI [n=10], and candidal UTI [n=6]. Management was inconsistent. Two children required new assisted ventilation but no other complications occurred. The diagnosis of UTI in NICU is hampered by use of urine collection methods that are subject to contamination. Outcome is generally excellent, but there is a great need for guidelines on management of positive urine cultures in the NICU

Resistance pattern of breakthrough urinary tract infections in children on antibiotic prophylaxis

Prophylactic antibiotics are commonly used for prevention of urinary tract infections [UTIs] in children. It was postulated that the organisms and resistance patterns of breakthrough infections would differ with the choice of antimicrobial prophylaxis. This was a retrospective descriptive study of all breakthroughs UTI from 2000 to 2006 in children over 1 month of age discharged from a referral children's hospital in Tehran, Iran on continuous antibiotic prophylaxis for UTIs. Fifty-seven children discharged on prophylaxis had breakthrough UTIs of which 32 [56%] had a previously diagnosed urinary tract anomaly. Escherichia coli was responsible for the majority of infections irrespective of choice of prophylaxis. Thirty-three of 56 breakthrough UTIs [59%] were with organisms that were resistant to the prophylactic antibiotic. There was an increased incidence of resistance to prophylaxis in children on cefixime [16 of 22; 78%] when compared with children on cephalexin [7 of 19; 37%; p = 0.02] and a trend toward increased resistance when compared with children on trimethoprim-sulfamethoxasole [3 of 8; 37%] [p = 0.10]. In conclusion, the resistance pattern of organisms causing breakthrough UTIs varies with the choice of prophylaxis which should be taken into consideration in choosing empiric therapy for such infections