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Trends in Intravenous Antibiotic Duration for Urinary Tract Infections in Young Infants
William W Lewis-de Los Angeles1, Cary Thurm2, Adam L Hersh3
1Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; wwlewis@gmail.com.
Insights
The duration of intravenous (IV) antibiotic treatment for urinary tract infections (UTIs) in young infants decreased significantly between 2005 and 2015. This shorter treatment duration was not associated with an increase in infant readmissions for UTIs.
Area of Science:
- Pediatric Infectious Diseases
- Neonatal Care
- Antibiotic Stewardship
Background:
- Urinary tract infections (UTIs) are common in infants.
- Intravenous (IV) antibiotic duration for infant UTIs has historically been long.
- Evidence for optimal IV antibiotic duration is evolving.
Purpose of the Study:
- To analyze trends in IV antibiotic duration for UTIs in infants ≤60 days old from 2005-2015.
- To determine if IV antibiotic duration impacts 30-day UTI readmission rates.
Main Methods:
- Retrospective analysis of infants ≤60 days old with UTIs from the Pediatric Health Information System database (2005-2015).
- Exclusion criteria included comorbidities, bacteremia, ICU admission, or prior surgery.
- Primary outcome was 30-day readmission for UTI.
Main Results:
- The use of 4+ days of IV antibiotics for infant UTIs decreased from 50% (2005) to 19% (2015).
- Variability in long IV treatment duration existed across hospitals (3%-59%).
- No correlation was found between long IV treatment duration and readmission (r=0.13, P=.37); younger age and female sex were associated with readmission.
Conclusions:
- Long IV antibiotic treatment for infant UTIs significantly decreased from 2005 to 2015.
- This trend occurred without an increase in hospital readmissions.
- Findings support the safety and feasibility of shorter IV antibiotic courses for select neonates with UTIs.
Objectives:
To assess trends in the duration of intravenous (IV) antibiotics for urinary tract infections (UTIs) in infants ≤60 days old between 2005 and 2015 and determine if the duration of IV antibiotic treatment is associated with readmission.
Methods:
Retrospective analysis of infants ≤60 days old diagnosed with a UTI who were admitted to a children's hospital and received IV antibiotics. Infants were excluded if they had a previous surgery or comorbidities, bacteremia, or admission to the ICU. Data were analyzed from the Pediatric Health Information System database from 2005 through 2015. The primary outcome was readmission within 30 days for a UTI.
Results:
The proportion of infants ≤60 days old receiving 4 or more days of IV antibiotics (long IV treatment) decreased from 50% in 2005 to 19% in 2015. The proportion of infants ≤60 days old receiving long IV treatment at 46 children's hospitals varied between 3% and 59% and did not correlate with readmission (correlation coefficient 0.13; P = .37). In multivariable analysis, readmission for a UTI was associated with younger age and female sex but not duration of IV antibiotic therapy (adjusted odds ratio for long IV treatment: 0.93 [95% confidence interval 0.52-1.67]).
Conclusions:
The proportion of infants ≤60 days old receiving long IV treatment decreased substantially from 2005 to 2015 without an increase in hospital readmissions. These findings support the safety of short-course IV antibiotic therapy for appropriately selected neonates.
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