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Urinary tract infection (UTI) is an among clinical problems in the neonatal period. Early and prompt diagnosis has important therapeutic implications. Clinical presentations are nonspecific and the severe disease may be fatal. There is scarce information in Tanzania regarding prevalence, aetiologies, antibiotic sensitivity and predictors of UTI among neonates. This study aimed at determining the prevalence, aetiology, antibiotics sensitivity and predictors of UTI among neonates with clinical sepsis who were admitted at Dodoma Regional Referral Hospital. This was a cross-sectional analytical hospital-based study which included 152 neonates admitted with clinical sepsis. All neonates were investigated for full blood picture, C-Reactive Protein (CRP), urine for dipstick and urine culture. Urine sample was collected by suprapubic aspiration and bacterial growth of single or more colony forming units/ml which was defined as UTI. Data were analyzed using SPSS version 20, logistic regression for univariate and multivariate analysis were used and P <0.05 was statistically significant.
Out of 152 neonates, 28 (18.4%) had UTI. Isolated organisms were Klebsiella pneumonia 18 (64.3%) and Enterobacter spp 10 (35.7%). The isolated organisms were 100% resistant to most commonly prescribed antibiotics (ceftriaxone, ampicillin, and gentamycin). Sensitive drugs were ciprofloxacin (90%) followed by amikacin (60%), nitrofurantoin (33.3%) and meropenem (27.8%). The predictors of UTI in neonates were low Apgar score (AOR = 12.758, 95% CI = 4.168-39.055, P <0.001), prolonged labour (AOR = 5.360, 95% CI = 1.276-22.523, P = 0.022), high CRP (AOR = 3.839, 95% CI = 1.401-10.517, P = 0.009), positive urine nitrites (AOR = 26.667, 95% CI 7.754-91.704, P<0.001),positive urine for leucocyte (AOR = 23.666, 95% CI = 7.462-75.052, P<0.001), high WBC count (AOR = 6.643, 95% CI = 1.472-29.968, P = 0.014), high neutrophil count (AOR = 8.907, 95% CI = 2.005-39.573, P = 0.004) and lymphocytic count (AOR = 3.677, 95% CI = 1.003-13.475, P = 0.0049).
The prevalence of UTI in this study was 18.4%. Klebsiella pneumoniae and Enterobacter spp were the isolates and had high resistance to ceftriaxone, ampicillin, and gentamycin. It is important to investigate UTI in neonates with signs of sepsis particularly those with low Apgar score, history of prolonged labour, high CRP, positive urine nitrite and leukocyte esterase and high WBC count. Further studies may be done on UTI in neonates particularly for exploring reasons of high antibiotic resistance. |
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