Catheter-obtained, Enterococcus and Proteus positive urine cultures may represent mostly contamination or asymptomatic bacteriuria in infants <90 days

Dvir Gatt, Idan Lendner, Shalom Ben-Shimol

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background: Urinary tract infection (UTI) diagnosis in infants is often made by a positive urine culture result, regardless of urine dipstick findings. Aim: To assess parameters that may affect positive urine culture results interpretation in infants, including dipstick performance, obtainment method, bacteria type, age and laboratory results. Methods: A retrospective, cohort study. Infants <90 days with urine dipstick and culture obtained through subrapubic aspiration (SPA) or catheter, 2015–2016, were included. Results: Overall, 19% (129/678) of cultures were positive. The dipstick sensitivity was 51% for all cultures; 66%, 47%, 15% and 10% for Escherichia coli (n= 71), Klebsiella (n= 19), Enterococcus (n= 34) and Proteus (n= 10), respectively (p<.001). Sensitivity was higher in SPA vs. catheter for all cultures (67% vs. 43%); E. coli (78% vs. 59%); and Klebsiella (88% vs. 18%). For Enterococcus, dipstick sensitivity was low in both SPA and catheter (0–16%). All Proteus episodes were catheter obtained. Positive culture with negative dipstick and Enterococcus episodes had lower C-reactive protein levels, and higher proportion of mixed infection compared with positive dipstick and E. coli episodes. Conclusions: Urine cultures in infants should be obtained by SPA, since catheter-obtained, Enterococcus and Proteus positive cultures may represent contamination or asymptomatic bacteriuria, rather than true UTI.

    Original languageEnglish
    Pages (from-to)332-339
    Number of pages8
    JournalInfectious Diseases
    Volume53
    Issue number5
    DOIs
    StatePublished - 1 Jan 2021

    Keywords

    • Urinary tract infection
    • asymptomatic bacteriuria
    • contamination
    • infants
    • supra-pubic aspiration (SPA)
    • urine catheter

    ASJC Scopus subject areas

    • Immunology and Microbiology (all)
    • Microbiology (medical)
    • Infectious Diseases

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