Patterns of microbial growth in urine cultures in a pediatric hematology/oncology unit over a one-year period

Abstract

BackgroundUrinary tract infections (UTIs) may present with nonspecific symptoms and without any definitive clinical signs other than fever, hence may be missed without a routine urine analysis. We retrospectively evaluated all cases of culture-positive urine infections in pediatric oncology patients in our center during the year 2015.MethodsWe assessed all positive urine culture incidents for pediatric patients receiving treatment and/or follow-up at our center during 2015. Analysis was performed on patients with regards to clinical, microbiology and pertinent lab findings as well as associated risk factors.ResultsThere were 151 episodes of documented positive urine cultures among 73 patients. Majority of positive urine cultures were found in solid tumor patients (41%), followed by hematological malignancies (26%). Most organisms detected were gram-negative organisms (84%), with E.coli being the most frequent (51%). Forty percent of bacteria were resistant to standard broad-spectrum antibiotics, with the majority being extended-spectrum beta-lactamase-producing. Most of these infections occurred in patients receiving prophylactic antibiotics (46 out of 50). Approximately two thirds of patients were not febrile on the day of culture (64%) and almost half of the reported episodes were associated with urinary symptoms. Pyuria, leukocyte esterase and nitrites were positive in 39%, 51% and 19% of samples, respectively.ConclusionsPositive urine culture in children with cancer may not be associated with urinalysis abnormalities, particularly in patients with neutropenia. When selecting empiric treatment for cancer patients with UTIs, one should take into consideration the institutional patterns for resistance and use of prophylactic antibiotics.

Role of urine studies in asymptomatic febrile neutropenic patients presenting to the emergency department

“…[22] Nevertheless, other studies reported higher rates of documented UTI (18.5% to 47.0%) in FN patients without signs or symptoms suggestive of UTI. [13,23] As a matter of fact, in one of those studies, only 2.2% of the patients presented with urinary symptoms, and none of those had signifi cant bacteriuria. [13] Herein, we conclude that the incidence of UTI in adult cancer patients with FN is low due to a constellation of factors.…”

“…[22] The rates reported in our study are similar to those of a study on pediatric oncology patients with confirmed UTI, where 69% of UA samples were abnormal, and 85% had an absolute neutrophil count (ANC) >500 cells/mm 3 . [23] These diff erences in the presence of a UA abnormality may be attributed to the severity of neutropenia as well as the urine collection technique; a higher ANC and bladder catheterization are signifi cantly associated with the presence of pyuria. [18] Moreover, in healthy patients, a negative UA result generally has a high negative predictive value (NPV).…”

“…Likewise, in a study on pediatric oncology patients with confirmed UTI, pyuria and LE were reported in 39% and 51% of all samples but only in 15% and 23% of neutropenic patients' samples, respectively. [23] For this reason, findings of pyuria and LE may be difficult to interpret in a neutropenic patient as more than half of the patients with UTI may show no pyuria or LE.…”

Gram-Positive Bacterial Infections and Antibiotics Resistance in Jordan: Current Status and Future Perspective

“…CoNS have been isolated from bovine samples and samples from sheep with mastitis [56][57][58][59][60][61][62][63] , the hands and mobile phones of university students 33 , air samples 138,139 and health care workers' uniforms in ICUs 140 . The most common CoNS species isolated from clinical samples in Jordan were S. epidermidis and S. haemolyticus 141 , and these were isolated from neonates with septicaemia 92,93,[142][143][144] , nosocomial septic arthritis patients 114 , cancer patients with bacteremia and febrile neutropenia 97,145 , patients with bloodstream infections 132,141 , patients with nosocomial infections 100 , patients with UTIs 102,104,106,107,[146][147][148] , patients with otitis externa 110 , children with bacterial infections following autologous hematopiotic stem cell transplantation 149 , patients with surgical site infections following coronary artery bypass graft surgery 150 , and patients with endocarditis 115 .…”

“…Enterococci were isolated form different clinical samples 12 , bacteremia in children 89 , bloodstream infections 79,132 , chemotherapy-induced febrile neutropenia with positive blood cultures 97 , bacterial infections in the first 90 days of life 178 , skin and soft tissue infections from ICU patients 85 , wound infections 82 , bile infections 99 , and nosocomial infections 100 . It was rarely isolated from UTIs 101,102,104,106,107,[146][147][148]160,177,[190][191][192][193] , dental diseases, 185 , sinusitis and orbital cellulitis 122 , combat-related traumatic chronic osteomyelitis 124 , and autologous hematopoietic stem cell transplantation in children 149 . E. faecalis was the most frequent isolate followed by E. faecium 100,189 .…”