Causative organisms and antimicrobial susceptibility in jaundiced infants with significant bacteriuria

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<jats:title>Background:</jats:title>
<jats:p>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 <jats:italic toggle="yes">E. coli</jats:italic> has been isolated. The aim of this study was to determine causative organisms and antimicrobial susceptibility in jaundiced infants with significant bacteriuria (SB).</jats:p>
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<jats:title>Methods:</jats:title>
<jats:p>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 10<jats:sup>5</jats:sup>-colony forming units per milliliter (CFU/ml) by sterile urinary collection bag or 10<jats:sup>4</jats:sup> CFU/ml by catheterization was isolated.</jats:p>
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<jats:title>Results:</jats:title>
<jats:p>A total of 88 (14.3%) of 615 asymptomatic jaundiced infants had positive urinary culture. <jats:italic toggle="yes">E coli</jats:italic> was the most common cultured bacteria (40 cases, [45.5%]). <jats:italic toggle="yes">Enterococcus faecalis</jats:italic> was the second most common bacteria (17 cases, [19.3%]). Seven cases (8.0%) of <jats:italic toggle="yes">Streptococcus agalactiae</jats:italic> and six cases (6.8%) of <jats:italic toggle="yes">Klebsiella pneumoniae</jats:italic> were also identified. Ampicillin sensitivity was found in 22.5% of <jats:italic toggle="yes">E. coli</jats:italic> infections, gentamicin sensitivity was found in 84.2%, and extended-spectrum <jats:italic toggle="yes">β</jats:italic>-lactamases were found in 7.5%.</jats:p>
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<jats:title>Conclusion:</jats:title>
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<jats:italic toggle="yes">E. coli</jats:italic> 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.</jats:p>
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