Urinary tract infection in full-term newborn infants: value of urine culture by bag specimen collection.

OBJECTIVE To evaluate the efficacy of urine culture by bag specimen for the detection of neonatal urinary tract infection in full-term newborn infants. Retrospective study (1997) including full-term newborn infants having a positive urine culture (> 100,000 CFU/ml) by bag specimen collection. The urinary tract infection diagnosis was confirmed by positive urine culture (suprapubic bladder aspiration method). The select cases were divided into three groups, according to newborn infant age at the bag specimen collection: GI (< 48 h, n = 17), GII (48 h to 7 d, n = 35) and GIII (> 7 d, n = 9). Sixty one full-term newborn infants were studied (5.1% of total infants). The diagnosis was confirmed on 19/61 (31.1%) of full-term infants born alive. Distribution among the groups was: GI = 2/17 (11.8%), GII = 10/35 (28.6%), and GIII = 7/9 (77.7%). The most relevant clinical symptoms were: fever (GI--100%, GII--91.4%) and weight loss (GI--35.3%, GII--45.7%). Urine culture results for specimens collected by suprapubic aspiration were: E. coli GI (100%), GII (40%) and GIII (28.6%), E. faecalis GI (30%), Staphylococcus coagulase-negative GII (20%) and GIII (42.8%), and Staphylococcus aureus GII (10%). Correlation between positive urine culture collection (bag specimen method) and urinary tract infection diagnosis, using relative risk analysis, produced the following results: GI = 0.30 (CI 95% 0.08-1.15), GII = 0.51 (CI 95% 0.25-1.06) and GIII = 3.31 (CI 95% 1.8-6.06). The most frequent urinary tract infection clinical signs in the first week were fever and weight loss, while non-specific symptomatology occurred later. E. coli was most frequent infectious agent, although from the 7th day of life, staphylococcus was noted. The urine culture (bag specimen method) was effective in detecting urinary tract infection only after the 7th day of life.