Topics Discussed: infectious diseases; neonatal urinary tract infection; urinary tract infection; urology and nephrology.
Excerpt:"Definition. Urinary tract infection (UTI) is the presence of pathogenic bacteria or fungus in the urinary tract with or without symptoms of infection. A definitive diagnosis is made by culture of any organism in a urine specimen that has been properly collected by suprapubic bladder aspiration (>10,000 col), ideally, or by gentle catheterization (>100,000 col).
Incidence. Various series report an incidence of 0.51.0% in term infants weighing >2500 g and higher rates (35%) in premature infants or infants weighing <2500 g. (Note: In the neonatal period, there is a greater incidence among males than females.) The predominant organisms are Gram-negative rods; Escherichia coli is the most common. In neonates, UTIs are most frequently acquired by hematogenous spread.
Pathophysiology. The three routes with which the urinary tract can become infected are retrograde ascent of fecal-perineal bacteria, introduction of bacteria into urinary system by instrumentation (eg, catheter insertion), or urinary tract involvement as part of a systemic infection (may see Gram-positive species). When a UTI is present in an infant <1 year of age, an associated urinary tract abnormality is found in ~50% of neonates. Associated anomalies that may give rise to a UTI include neurogenic bladder, posterior urethral valves, vesicoureteral reflux, and ureteropelvic junction obstruction.
Risk factors include..."
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