Division of Neonatology, Changhua Christian Children's Hospital, Changhua City, Taiwan, ROC.
Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2022 Apr 1;85(4):514-518. doi: 10.1097/JCMA.0000000000000698.
Jaundice may be one of the first signs of urinary tract infection (UTI) in infants. The most common pathogen is Escherichia coli. Currently recommended antibiotic treatment for neonatal UTI is ampicillin and an aminoglycoside. Recently, increasing ampicillin and gentamicin resistance in strains of E. coli has been isolated. The aim of this study was to determine causative organisms and antimicrobial susceptibility in jaundiced infants with significant bacteriuria (SB).
We evaluated admitted afebrile, asymptomatic infants younger than 1-month old with hyperbilirubinemia (total bilirubin >15 mg/dl) requiring phototherapy between January 2011 and December 2015. A total of 615 asymptomatic jaundiced infants were enrolled. Urinalysis and urine cultures were performed on all jaundiced infants. A urine culture was defined as SB if a single pathogen with more than 105-colony forming units per milliliter (CFU/ml) by sterile urinary collection bag or 104 CFU/ml by catheterization was isolated.
A total of 88 (14.3%) of 615 asymptomatic jaundiced infants had positive urinary culture. E coli was the most common cultured bacteria (40 cases, [45.5%]). Enterococcus faecalis was the second most common bacteria (17 cases, [19.3%]). Seven cases (8.0%) of Streptococcus agalactiae and six cases (6.8%) of Klebsiella pneumoniae were also identified. Ampicillin sensitivity was found in 22.5% of E. coli infections, gentamicin sensitivity was found in 84.2%, and extended-spectrum β-lactamases were found in 7.5%.
E. coli was the most common causative organism for infants with SB. We suggest modifying current empiric antibiotics by changing gentamicin to amikacin for neonatal Gram-negative bacterial infections.
黄疸可能是婴儿尿路感染 (UTI) 的最初迹象之一。最常见的病原体是大肠杆菌。目前推荐的新生儿 UTI 抗生素治疗是氨苄西林和氨基糖苷类药物。最近，从大肠杆菌中分离出的菌株对氨苄西林和庆大霉素的耐药性逐渐增加。本研究旨在确定有显著菌尿症 (SB) 的黄疸婴儿的病原体和抗菌药物敏感性。
我们评估了 2011 年 1 月至 2015 年 12 月期间因高胆红素血症（总胆红素>15mg/dl）需要光疗且无发热、无症状、小于 1 个月的入院婴儿。共纳入 615 例无症状黄疸婴儿。对所有黄疸婴儿进行尿液分析和尿液培养。无菌尿收集袋中单个病原体超过 105 个菌落形成单位/毫升 (CFU/ml) 或通过导管分离出 104 CFU/ml 的尿液培养被定义为 SB。
615 例无症状黄疸婴儿中，共有 88 例（14.3%）尿液培养阳性。大肠杆菌是最常见的培养细菌（40 例，[45.5%]）。粪肠球菌是第二常见的细菌（17 例，[19.3%]）。还鉴定出 7 例（8.0%）无乳链球菌和 6 例（6.8%）肺炎克雷伯菌。氨苄西林对 22.5%的大肠杆菌感染敏感，庆大霉素敏感率为 84.2%，对扩展谱β-内酰胺酶的敏感性为 7.5%。
大肠杆菌是 SB 婴儿最常见的病原体。我们建议通过将庆大霉素改为阿米卡星来改变新生儿革兰氏阴性细菌感染的经验性抗生素治疗方案。
