Short duration of parenteral antibiotics in infants with urinary tract infections
Nikita Menon1, Anne Mutinta Deasy2, Kellan Woo1
1Vancouver-Fraser Medical Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.
Insights
A short course of parenteral antibiotics is safe for young, non-bacteremic infants with urinary tract infections (UTIs). This approach significantly reduces hospital length of stay, offering a valuable quality improvement opportunity.
Area of Science:
- Pediatric Infectious Diseases
- Antibiotic Stewardship
Background:
- Canadian Paediatric Society guidelines exclude infants ≤60 days for UTI treatment.
- Significant practice variability exists regarding parenteral antibiotic duration in young infants with UTIs.
Purpose of the Study:
- Assess local practice patterns for urinary tract infection (UTI) management in infants ≤60 days.
- Evaluate the safety and efficacy of a short course (≤3 days) of parenteral antibiotics in this population.
Main Methods:
- Retrospective cohort study of 95 infants (≤60 days) with confirmed UTIs.
- Comparison of outcomes between short (≤3 days) and long (>3 days) parenteral antibiotic durations.
- Outcomes included UTI recurrence, hospital length of stay, representation, and readmission.
Main Results:
- Twenty infants received a short antibiotic course; they were older and non-bacteremic.
- UTI recurrence was 8%, with no significant difference between short and long courses.
- Short-course treatment significantly reduced hospital length of stay by a mean of 4.21 days.
Conclusions:
- A short parenteral antibiotic course is safe for non-bacteremic infants with UTIs in a Canadian setting.
- Practice patterns indicate a trend towards longer antibiotic courses, highlighting a quality improvement need.
- Optimizing antibiotic duration can lead to shorter hospital stays and efficient resource utilization.
Objectives:
Current guidelines by the Canadian Paediatric Society on treating urinary tract infections (UTIs) exclude infants ≤ 60 days old. There is considerable practice variability in this age group, especially around the optimal duration of parenteral antibiotics. The study aimed to assess local practice patterns, and the safety of a short course (≤3 days) of parenteral antibiotics in young infants.
Methods:
In this retrospective cohort study, 95 infants (≤60 days) with confirmed UTIs were identified at British Columbia Children's Hospital. Patients receiving short (≤3 days) and long (>3 days) duration of parenteral antibiotics were compared. Outcomes of interest included urinary tract infection recurrence within 30 days, hospital length of stay (LOS), representation, and readmission.
Results:
Twenty infants (21%) received a short course of parenteral antibiotics. These infants were older (median 47 days versus 28 days) and non-bacteremic. Urinary tract infection recurrence was identified in 8 patients (8%), of which 7 were treated with a long duration (P = 1.0). Patients treated with a short duration had a significantly shorter LOS, with a mean difference of 4.21 days [95% CI: 3.37 to 5.05] (P < 0.001). All five (5%) bacteremic patients were treated exclusively with parenteral antibiotics.
Conclusions:
In a Canadian setting, a short course of parenteral antibiotics is safe in young, non-bacteremic infants with UTIs. Despite substantial evidence, local practice patterns suggest a tendency towards prescription of long courses, providing an opportunity for quality improvement.
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