Bahat Ozdogan Elif, Mutlu Mehmet, Camlar Secil Arslansoyu, Bayramoglu Gülcin, Kader Sebnem, Aslan Yakup
Department of Pediatrics, Division of Pediatric Nephrology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey.
Department of Pediatrics, Division of Neonatology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey.
Pediatr Neonatol. 2018 Jun;59(3):305-309. doi: 10.1016/j.pedneo.2017.10.010. Epub 2017 Oct 28.
It is controversial to test for urinary tract infection (UTI) in patients with unexplained indirect hyperbilirubinemia in the first 2 weeks of life. We aimed to study the prevalence and significance of UTIs in such neonates who were requiring phototherapy.
Subjects were 2- to 14-day-old neonates with indirect bilirubin levels above phototherapy limit with no other abnormality in their bilirubinaemia-related etiologic workup. UTI was diagnosed by 2 consecutive positive cultures obtained by catheterisation, documenting growth of >10,000 colonies of the same microorganism with consistent antibiograms. The UTI (+) patients were evaluated by renal ultrasonography (US), and some were followed up for possible recurrent UTI.
262 neonates were included in the study. UTI prevalence was 12.2%, and bacteraemia was 6.2% among UTI (+) patients. The two most common pathogens (81.2%) were Escherichiacoli and Klebsiella. pneumonia. All UTI (+) patients had undergone US, revealing 12.5% pelvicaliectasis, other 12.5% increased renal parenchymal echogenicity, 3.1% concurrent pelvicaliectasis and increased renal parenchymal echogenicity. 53.1% of UTI (+) patients had undergone follow-up, after which 23.5% recurrent UTI were found at the end of a mean of 52 months.
We suggest that the neonates with unexplained pathological jaundice should be tested for possible UTI. Consequently, all newborns with UTI shall be evaluated by the urinary US and followed up for recurrent UTI.
对于出生后前2周出现不明原因间接胆红素血症的患者，是否进行尿路感染（UTI）检测存在争议。我们旨在研究此类需要光疗的新生儿中UTI的患病率及意义。
研究对象为2至14日龄的新生儿，其间接胆红素水平高于光疗阈值，且在与胆红素血症相关的病因检查中无其他异常。通过导尿获得连续2次阳性培养结果来诊断UTI，记录同一微生物菌落数>10,000且抗菌谱一致。对UTI（+）患者进行肾脏超声（US）检查，部分患者进行随访以观察是否可能复发UTI。
262例新生儿纳入研究。UTI患病率为12.2%，UTI（+）患者中菌血症患病率为6.2%。两种最常见的病原体（81.2%）为大肠埃希菌和肺炎克雷伯菌。所有UTI（+）患者均接受了US检查，结果显示12.5%有肾盂扩张，12.5%肾实质回声增强，3.1%同时存在肾盂扩张和肾实质回声增强。53.1%的UTI（+）患者接受了随访，平均52个月后，发现23.5%复发UTI。
我们建议对不明原因病理性黄疸的新生儿进行UTI检测。因此，所有UTI新生儿均应接受泌尿系统US检查并随访观察是否复发UTI。
