From the Guidelines
Urinary tract infections (UTIs) in male neonates are primarily caused by bacterial pathogens, with Escherichia coli being the most common organism, accounting for approximately 80% of cases, as reported in the most recent study 1. The most common cause of UTI in neonate males is bacterial infection, with other causative bacteria including Klebsiella, Enterobacter, Citrobacter, Proteus, Pseudomonas, Enterococcus, and Staphylococcus species. Some key points to consider in the diagnosis and management of UTIs in male neonates include:
- Congenital anomalies of the urinary tract, particularly vesicoureteral reflux (VUR), which allows backflow of urine from the bladder to the kidneys, are often associated with UTIs in male neonates, as noted in 1 and 1.
- Other structural abnormalities that can cause UTIs include posterior urethral valves, ureteropelvic junction obstruction, and ureterocele.
- Uncircumcised male infants have a higher risk of developing UTIs compared to circumcised males due to bacterial colonization of the prepuce.
- Additional risk factors include improper hygiene, urinary stasis, constipation, neurogenic bladder, and immunodeficiency states.
- Premature infants and those with prolonged hospital stays or who have undergone urinary catheterization are also at increased risk, as mentioned in 1. Any male neonate with a confirmed UTI should undergo renal ultrasonography to evaluate for structural abnormalities, and a voiding cystourethrogram (VCUG) may be indicated to assess for VUR, as recommended in 1. It is essential to note that the diagnosis and management of UTIs in male neonates require careful consideration of these factors to ensure optimal outcomes and prevent long-term sequelae. The use of imaging studies, such as ultrasound and VCUG, can help identify underlying structural abnormalities and guide management decisions, as discussed in 1 and 1. Overall, a comprehensive approach to the diagnosis and management of UTIs in male neonates is crucial to minimize morbidity, mortality, and improve quality of life, as emphasized in 1.
From the Research
Cause of UTI in Neonate Male
- The cause of UTI in neonate males can be attributed to various factors, including bacterial infections 2.
- A study found that the majority of UTI cases in neonates were initial infections, with Escherichia coli (40.68%) and Enterococcus spp. (33.90%) being the most prevalent strains 2.
- Urinary system malformations, such as pelviureteric junction obstruction, were also prevalent in neonates with UTIs 2.
- The clinical characteristics of UTIs in neonates varied based on gestational age, with premature infants exhibiting a higher incidence of fever 2.
- A high prevalence of positive nitrite tests and elevated white blood cell counts were also indicated in urinalysis results 2.
Bacterial Aetiology
- The most common bacterial strains causing UTIs in neonates were Escherichia coli and Enterococcus spp. 2.
- Antibiotic susceptibility testing showed varying susceptibility profiles among bacterial species, emphasizing the importance of tailored antibiotic selection based on resistance patterns 2.
Diagnosis and Management
- Diagnosis of UTIs in neonates is crucial, and prompt treatment reduces renal scarring 3, 4.
- Urine culture is needed for definitive diagnosis, and antibiotic selection should be based on local sensitivity patterns and adjusted once culture results are available 4.
- Identification and treatment of bowel and bladder dysfunction can prevent UTI recurrence 4.