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Management and Outcomes in Children with Third-Generation Cephalosporin-Resistant Urinary Tract Infections
Marie E Wang1, Tara L Greenhow2, Vivian Lee3
1Division of Pediatric Hospital Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Stanford, California, USA.
Insights
Predictors for prolonged parenteral antibiotic therapy in pediatric urinary tract infections (UTIs) include young age and genitourinary issues. UTI relapse was rare and not linked to therapy duration, suggesting careful antibiotic selection is key.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
Background:
- Third-generation cephalosporin-resistant urinary tract infections (UTIs) in children present treatment challenges, often necessitating prolonged parenteral antibiotic courses due to limited oral options.
- Identifying factors predicting extended parenteral therapy and its impact on UTI recurrence is crucial for optimizing pediatric UTI management.
Purpose of the Study:
- To determine predictors of long parenteral antibiotic therapy in children with third-generation cephalosporin-resistant UTIs.
- To assess the association between parenteral therapy duration and UTI relapse in this pediatric population.
Main Methods:
- A multisite retrospective cohort study was conducted involving children under 18 years with third-generation cephalosporin-resistant UTIs caused by Escherichia coli or Klebsiella spp.
- Long parenteral therapy was defined as ≥3 days of concordant antibiotics; short/no therapy was 0-2 days. Relapse was defined as the same organism causing a UTI within 30 days.
Main Results:
- Of 482 children, 11.2% received long parenteral therapy (median 7 days). Key predictors included age <2 months (aOR 67.3), limited oral antibiotic options (aOR 5.9), and genitourinary abnormalities (aOR 5.4).
- UTI relapse rates were similar between long (1.9%) and short/no parenteral therapy (1.5%) groups (P=.57). Among those exclusively on discordant antibiotics, 2.9% experienced relapse.
Conclusions:
- Younger age (<2 months), limited oral antibiotic choices, and genitourinary abnormalities predict the need for prolonged parenteral antibiotic treatment in pediatric resistant UTIs.
- UTI relapse is infrequent and not significantly associated with parenteral therapy duration, highlighting the importance of appropriate antibiotic selection over prolonged parenteral courses.
Background:
Third-generation cephalosporin-resistant urinary tract infections (UTIs) often have limited oral antibiotic options with some children receiving prolonged parenteral courses. Our objectives were to determine predictors of long parenteral therapy and the association between parenteral therapy duration and UTI relapse in children with third-generation cephalosporin-resistant UTIs.
Methods:
We conducted a multisite retrospective cohort study of children <18 years presenting to acute care at 5 children's hospitals and a large managed care organization from 2012 to 2017 with a third-generation cephalosporin-resistant UTI from Escherichia coli or Klebsiella spp. Long parenteral therapy was ≥3 days and short/no parenteral therapy was 0-2 days of concordant parenteral antibiotics. Discordant therapy was antibiotics to which the pathogen was non-susceptible. Relapse was a UTI from the same organism within 30 days.
Results:
Of the 482 children included, 81% were female and the median age was 3.3 years (interquartile range: 0.8-8). Fifty-four children (11.2%) received long parenteral therapy (median duration: 7 days). Predictors of long parenteral therapy included age <2 months (adjusted odds ratio [aOR] 67.3; 95% confidence interval [CI]: 16.4-275.7), limited oral antibiotic options (aOR 5.9; 95% CI: 2.8-12.3), and genitourinary abnormalities (aOR 5.4; 95% CI: 1.8-15.9). UTI relapse occurred in 1 of the 54 (1.9%) children treated with long parenteral therapy and in 6 of the 428 (1.5%) children treated with short/no parenteral therapy (P = .57). Of the 105 children treated exclusively with discordant antibiotics, 3 (2.9%, 95% CI: 0.6%-8.1%) experienced UTI relapse.
Conclusions:
Long parenteral therapy was associated with age <2 months, limited oral antibiotic options, and genitourinary abnormalities. UTI relapse was rare and not associated with duration of parenteral therapy. For UTIs with limited oral options, further research is needed on the effectiveness of continued discordant therapy.
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