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Bacteraemic urinary tract infection: management and outcomes in young infants
Alan R Schroeder1, Mark W Shen2, Eric A Biondi3
1Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California, USA Stanford University School of Medicine, Stanford, California, USA.
Insights
Treatment duration for infant bacteraemic urinary tract infection (UTI) varied significantly. Shorter parenteral antibiotic courses may be safe, as relapses were rare and not linked to treatment length in this study.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Bacteraemic urinary tract infection (UTI) in infants under 3 months requires careful management.
- Parenteral antibiotic therapy is standard, but optimal duration is debated.
- Predictors of treatment duration and relapse risk are not well-defined.
Purpose of the Study:
- To identify factors influencing parenteral antibiotic duration in infants with bacteraemic UTI.
- To assess the relationship between parenteral antibiotic duration and the risk of UTI relapse.
Main Methods:
- Multicentre retrospective cohort study involving 251 infants <3 months with bacteraemic UTI.
- Data collected from 11 US healthcare institutions.
- Analyzed duration of parenteral antibiotics and occurrence of relapsed UTI within 30 days.
Main Results:
- Mean parenteral antibiotic duration was 7.8 days, with significant institutional variability (5.5-12 days).
- Predictors of longer duration included male gender, non-E. coli infection, and positive repeat blood culture.
- Relapsed UTI occurred in 2.4% of infants (without bacteraemia); no relapsed bacteraemic UTI was observed.
- Parenteral antibiotic duration did not differ between infants with and without relapse (p=0.81).
Conclusions:
- Parenteral antibiotic duration for infant bacteraemic UTI is highly variable and not well-explained by patient factors.
- Relapses are uncommon and not associated with antibiotic treatment duration.
- Shorter parenteral antibiotic courses may be considered for select infants with bacteraemic UTI.
Objectives:
To determine predictors of parenteral antibiotic duration and the association between parenteral treatment duration and relapses in infants <3 months with bacteraemic urinary tract infection (UTI).
Design:
Multicentre retrospective cohort study.
Setting:
Eleven healthcare institutions across the USA.
Patients:
Infants <3 months of age with bacteraemic UTI, defined as the same pathogenic organism isolated from blood and urine.
Main Outcome Measures:
Duration of parenteral antibiotic therapy, relapsed UTI within 30 days.
Results:
The mean (±SD) duration of parenteral antibiotics for the 251 included infants was 7.8 days (±4 days), with considerable variability between institutions (mean range 5.5-12 days). Independent predictors of the duration of parenteral antibiotic therapy included (coefficient, 95% CI): age (-0.2 days, -0.3 days to -0.08 days, for each week older), year treated (-0.2 days, -0.4 to -0.03 days for each subsequent calendar year), male gender (0.9 days, 0.01 to 1.8 days), a positive repeat blood culture during acute treatment (3.5 days, 1.2-5.9 days) and a non-Escherichia coli organism (2.2 days, 0.8-3.6 days). No infants had a relapsed bacteraemic UTI. Six infants (2.4%) had a relapsed UTI (without bacteraemia). The duration of parenteral antibiotics did not differ between infants with and without a relapse (8.2 vs 7.8 days, p=0.81).
Conclusions:
Parenteral antibiotic treatment duration in young infants with bacteraemic UTI was variable and only minimally explained by measurable patient factors. Relapses were rare and were not associated with treatment duration. Shorter parenteral courses may be appropriate in some infants.
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