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Use of Fever Duration to Guide Management of Urinary Tract Infection
Takeshi Yanagihara1,2, Koichi Kobayashi1, Emi Yanai2
1Department of Pediatrics, Nippon Medical School Hospital.
Insights
A new protocol using fever duration to guide antibiotic treatment for febrile urinary tract infections (fUTI) in children proved effective. This approach eliminated the need for invasive imaging like computed tomography scans.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
Background:
- The optimal duration of antimicrobial therapy for febrile urinary tract infections (fUTI) in children remains undefined.
- Establishing evidence-based treatment guidelines is crucial for effective pediatric care.
Purpose of the Study:
- To evaluate a novel protocol for determining antimicrobial treatment duration in pediatric fUTI based on fever resolution.
- To assess the efficacy and necessity of advanced imaging in diagnosing fUTI complications.
Main Methods:
- A protocol was implemented where antibiotic administration continued until 3 days post-fever resolution, followed by oral therapy.
- Febrile urinary tract infection diagnosis required a temperature of ≥37.5°C and urine culture counts of ≥5 × 10⁴ CFU/mL.
- Contrast-enhanced computed tomography (eCT) was used to diagnose acute focal bacterial nephritis (AFBN) and pyelonephritis (PN).
Main Results:
- Of 58 analyzed patients, 49 had pyelonephritis (PN) and nine had acute focal bacterial nephritis (AFBN).
- Patients with AFBN showed higher white blood cell counts and C-reactive protein levels, but similar urinary findings and causative bacteria compared to PN.
- While AFBN patients had longer fever resolution and IV antibiotic durations, the average AFBN treatment was 14.2 days, shorter than previous reports, with no recurrences.
Conclusions:
- A fever-duration-guided antimicrobial treatment protocol is effective for pediatric fUTI.
- The study suggests that invasive imaging like eCT may not be necessary for managing fUTI and its complications.
Background:
The appropriate duration of antimicrobial therapy for febrile urinary tract infection (fUTI) in children has not been established. This study examined the optimal duration of treatment for fUTI in children.
Methods:
We created a protocol that used fever duration to determine the duration of antibiotic administration. Transvenous antibiotics were administered until 3 days after resolution of fever, followed by oral antibiotics for 1 week. Diagnosis of fUTI was based on a fever of 37.5°C or higher and a quantitative culture of catheterized urine yielded a bacteria count of ≥5 × 104. Acute focal bacterial nephritis (AFBN) and pyelonephritis (PN) were diagnosed on the basis of contrast-enhanced computed tomography (eCT) findings. We retrospectively reviewed treatment outcomes.
Results:
Of the 78 patients treated according to our protocol, data from 58 were analyzed-49 children (30 boys) had PN and nine (three boys) had AFBN. Blood test results showed that patients with AFBN had significantly higher white blood cell counts and C-reactive protein levels than did those with PN; however, urinary findings and causative bacteria did not differ between groups. Time to resolution of fever and duration of intravenous antibiotic administration were significantly longer in patients with AFBN than in those with PN. However, average duration of AFBN treatment was 14.2 days, which was shorter than the previously reported administration period of 3 weeks. No recurrence was observed in AFBN patients.
Conclusions:
A protocol that used fever duration to determine the duration of antimicrobial treatment was useful. Invasive examinations, such as eCT, were not required.
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