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Treatment of UTIs in Infants <2 Months: A Living Systematic Review
Nassr Nama1,2, Robine Donken3, Colleen Pawliuk4
1Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada nassr.nama@alumni.ubc.ca.
Insights
Short antibiotic courses for infant urinary tract infections (UTIs) show similar recurrence risks compared to longer durations. This finding aids in optimizing treatment guidelines for neonates and young infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Urinary tract infections (UTIs) are common in infants under two months.
- Current antibiotic duration guidelines for this age group are unclear.
Purpose of the Study:
- To compare the efficacy of different parenteral antibiotic durations (≤3 vs >3 days) for UTIs in infants <2 months.
- To assess the impact of total antibiotic course duration (≤10 vs >10 days) on UTI recurrence.
Main Methods:
- Living systematic review including randomized controlled trials and observational studies.
- Crowdsourcing methodology for citation screening and data extraction.
- Random-effects models used for outcome pooling.
Main Results:
- No significant difference in UTI recurrence risk between short (≤3 days) and long (>3 days) parenteral antibiotic durations (OR: 1.02, 95% CI: 0.64-1.61).
- No significant difference in recurrence risk based on total antibiotic duration (≤10 vs >10 days) (OR: 1.29, 95% CI: 0.45-3.66).
- Low-certainty evidence from retrospective studies.
Conclusions:
- Short and long parenteral antibiotic durations are associated with similar UTI recurrence risks in infants <2 months.
- Evidence suggests potential for shorter antibiotic courses, but further research is needed due to low-certainty evidence.
Context:
Urinary tract infections (UTIs) are the most common bacterial infections in infants <2 months of age. However, there are no clear guidelines on the appropriate duration of antibiotics in this age group.
Objective:
In this living systematic review, we compared different durations of parenteral antibiotics (≤3 vs >3 days) in neonates and young infants (<2 months) with UTIs. The secondary objective was to compare different durations of total antibiotic courses (≤10 vs >10 days).
Data Sources:
MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Google Scholar, and gray literature, up to March 2, 2021.
Study Selection:
Citations were screened in triplicate by using a crowdsourcing methodology, to identify randomized controlled trials and observational studies.
Data Extraction:
Data were extracted by 2 crowd members and verified by an expert investigator. Outcomes were pooled via random-effects models.
Results:
A total of 10 334 citations were screened, and 12 eligible studies were identified. A total of 59 of 3480 (1.7% [95% confidence interval (CI): 1.3% to 2.2%]) infants had a UTI recurrence within 30 days after short parenteral treatment (≤3 days), and 47 of 1971 (2.4% [95% CI: 1.8% to 3.2%]) after longer courses. The pooled adjusted odds ratio for UTI recurrence with a short versus long duration of parenteral antibiotics was 1.02 (95% CI: 0.64 to 1.61; P = .95; n = 5451). A total of 5 studies assessed the risk of recurrence on the basis of the total duration of antibiotics (≤10 vs >10 days) with no significant differences (pooled odds ratio: 1.29 [95% CI: 0.45 to 3.66; P = .63; n = 491).
Conclusions:
On the basis of retrospective studies and Grading of Recommendations, Assessment, Development, and Evaluation level low evidence, short and long duration of parenteral antibiotics were associated with a similar risk of UTI recurrence in infants <2 months.
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