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Published on: August 5, 2010
Parenteral Antibiotic Therapy Duration in Young Infants With Bacteremic Urinary Tract Infections
Sanyukta Desai1, Paul L Aronson2,3,4, Veronika Shabanova2,5
1Divisions of Hospital Medicine and sanyukta.desai86@gmail.com.
Insights
Short-course parenteral antibiotics (≤7 days) for infants with bacteremic urinary tract infection (UTI) showed no increased risk of recurrence or rehospitalization compared to longer courses. This suggests shorter antibiotic durations may be safe for young infants with bacteremic UTI.
Area of Science:
- Pediatric Infectious Diseases
- Neonatal Research
- Antibiotic Stewardship
Background:
- Bacteremic urinary tract infection (UTI) in young infants requires careful management.
- Optimal parenteral antibiotic duration for bacteremic UTI in neonates remains debated.
- Antibiotic stewardship is crucial in pediatric care.
Purpose of the Study:
- To evaluate the association between parenteral antibiotic duration and clinical outcomes in infants younger than 60 days with bacteremic UTI.
- To compare 30-day UTI recurrence and all-cause reutilization between short-course (≤7 days) and long-course (>7 days) antibiotic therapy.
- To inform evidence-based guidelines for antibiotic use in this vulnerable population.
Main Methods:
- Multicenter retrospective cohort study of infants ≤60 days with concurrent blood and urine pathogen growth (2011-2016).
- Defined short-course (≤7 days) and long-course (>7 days) parenteral antibiotic durations.
- Utilized propensity scores, inverse probability weighting, and marginal structural models to adjust for confounding factors and assess outcomes.
Main Results:
- Among 115 infants, 50% received short-course antibiotics.
- Infants receiving long-course therapy were more likely to appear ill or have non-E. coli pathogens.
- No significant differences in adjusted 30-day UTI recurrence or all-cause reutilization between short- and long-course groups were observed.
Conclusions:
- Parenteral antibiotic therapy of ≤7 days for infants with bacteremic UTI is not associated with increased risk of recurrent UTI or hospital reutilization.
- Short-course parenteral antibiotic therapy, potentially with early oral switch, can be considered for select young infants with bacteremic UTI.
- Findings support optimizing antibiotic duration to minimize exposure and promote stewardship in neonatal care.
Objectives:
To determine the association between parenteral antibiotic duration and outcomes in infants ≤60 days old with bacteremic urinary tract infection (UTI).
Methods:
This multicenter retrospective cohort study included infants ≤60 days old who had concomitant growth of a pathogen in blood and urine cultures at 11 children's hospitals between 2011 and 2016. Short-course parenteral antibiotic duration was defined as ≤7 days, and long-course parenteral antibiotic duration was defined as >7 days. Propensity scores, calculated using patient characteristics, were used to determine the likelihood of receiving long-course parenteral antibiotics. We conducted inverse probability weighting to achieve covariate balance and applied marginal structural models to the weighted population to examine the association between parenteral antibiotic duration and outcomes (30-day UTI recurrence, 30-day all-cause reutilization, and length of stay).
Results:
Among 115 infants with bacteremic UTI, 58 (50%) infants received short-course parenteral antibiotics. Infants who received long-course parenteral antibiotics were more likely to be ill appearing and have growth of a non-Escherichia coli organism. There was no difference in adjusted 30-day UTI recurrence between the long- and short-course groups (adjusted risk difference: 3%; 95% confidence interval: -5.8 to 12.7) or 30-day all-cause reutilization (risk difference: 3%; 95% confidence interval: -14.5 to 20.6).
Conclusions:
Young infants with bacteremic UTI who received ≤7 days of parenteral antibiotics did not have more frequent recurrent UTIs or hospital reutilization compared with infants who received long-course therapy. Short-course parenteral therapy with early conversion to oral antibiotics may be considered in this population.
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