Frequency and prevention of recurrent Urinary Tract Infections (UTI) in hospitalized infants

OBJECTIVE: We investigated the frequency and prevention of recurrent UTI in infants requiring prolonged hospitalization in the neonatal intensive care unit (NICU). METHODS: A retrospective review of all male infants admitted to the NICU from June 1996-September 1998 revealed 31/595 males with UTI. Infants were divided into 3 Groups: A₁ < 37 weeks with 1 UTI, A₂ < 37 weeks with >1 UTI, and B ≥37 weeks with any UTI. Gestational age, birth weight, age at diagnosis of UTI, microorganisms, follow-up care (including imaging studies) and recurrence rates prior to discharge were determined. The effect of circumcision on recurrence of UTI was also investigated. RESULTS: Thirty-one infants had 44 UTIs during the study period (5.2%). In Groups A₁ and A₂, 50% of the first UTI were due to Candida ( 11/28) or E. coli (4/28), the remaining 50% were due to other Gram negatives and Staph. species. Mean gestational age (GA) in groups A₁ and A₂ were similar (29 ± 2 and 29 ± 4 weeks); GA was 39 weeks for all 3 infants in Group B. However, mean GA of infants with Candida UTI was 27 ± 2 weeks, and for bacterial UTI 30 ± 3 weeks (p<.01). 1st 2nd 3rd Abnormal Predominant DOL UTI UTI UTI U/S VCUG Organism Rx (days) Circumcision Group A₁ 38 0 0 4/17 2/21 Candida, 14 67 (n=19) E. Coli Group A₂ 40 63 99 3/9 1/7 Candida, 18 111 (n=9) E. coli Group B 85 0 0 1/3 1/2 Candida, 11 99 (n=3) Enterococcus CONCLUSIONS: Premature uncircumcised males have an increased risk for UTI (Odds Ratio=8.2, 95% Cl, 2.3-22.9, p<.001). Circumcision appears beneficial in reducing the risk for recurrent UTI in these same infants.