Clinical Profile of Urinary Tract Infections in Neonates with Suspected Sepsis: A Prospective Observational Study

Abstract

Background: Neonatal urinary tract infections (UTIs) frequently present with
nonspecific signs overlapping sepsis, leading to diagnostic delays and risk of renal
injury. Data on prevalence, microbiology, and risk factors in Indian neonatal
intensive care units are limited.
Objectives: To determine the prevalence, clinical presentation, microbiological
profile, and perinatal risk factors for culture-confirmed UTIs among neonates
evaluated for suspected sepsis.
Methods: In this prospective observational cohort study (January–December 2024)
at the Level III NICU of Sree Mookambika Institute of Medical Sciences, 106
neonates (≤28 days old) with suspected sepsis underwent standardized catheterized
urine sampling alongside blood cultures. Significant bacteriuria was defined as
≥10^5 CFU/mL. Clinical data, perinatal history, and laboratory results were
recorded. Categorical comparisons utilized chi-square or Fisher’s exact tests;
continuous variables were analysed by t-tests or Mann–Whitney U tests. Multivariate
logistic regression identified independent predictors of UTI, with significance at p <
0.05.
Results: UTI prevalence was 15.1%. Preterm neonates exhibited higher UTI rates
than term infants (23.7% vs. 10.3%; p = 0.044). PROM > 12 hours was also
associated with UTI (20.6% vs. 12.5%; p = 0.043). Escherichia coli predominated
(62.5%), of which 80% were ESBL‐producers. UTI-positive neonates had longer
hospital stays (12.5 ± 4.1 vs. 10.2 ± 3.6 days; p = 0.003).
Conclusion: Routine catheterized urine culture in neonatal sepsis evaluations
identifies a substantial UTI burden, particularly among preterm infants and those
with prolonged membrane rupture. High ESBL rates underscore the need for local
antibiogram–guided empirical therapy. Incorporating standardized urine screening
into sepsis protocols may enable timely, targeted treatment and reduce renal
sequelae.