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Association Between Antibiotic Duration and Recurrence of Urinary Tract Infection in the Neonatal Critical Care Unit
Kimberly Van1, Priyanka H Patel1, Kristen Jones1
1Department of Pharmacy (KV, PHP, KJ, CJ, NF, AP), AdventHealth for Children, Orlando, FL. NF was a pharmacy student at the University of Florida College of Pharmacy at the time of this study.
Insights
This study found no significant difference in recurrent urinary tract infections (UTIs) between infants treated for more or less than 7 days. However, shorter treatment durations showed a higher incidence of recurrent UTIs in subgroup analysis.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Clinical Pharmacology
Background:
- Urinary tract infections (UTIs) are common in infants, with current guidelines recommending 7–14 days of antibiotic therapy.
- Suboptimal UTI treatment may lead to recurrent infections, renal scarring, and chronic kidney disease.
- Neonatal intensive care units (NICUs) are high-risk environments for infant infections.
Purpose of the Study:
- To evaluate the association between antibiotic therapy duration and recurrent UTIs in NICU infants.
- To identify risk factors and common pathogens associated with recurrent UTIs in this population.
Main Methods:
- Infants admitted to the NICU and treated for UTIs were identified via diagnosis codes.
- Patients were categorized into two groups: antibiotic treatment for ≤7 days or >7 days.
- Recurrent UTI rates, risk factors, and causative organisms were analyzed.
Main Results:
- Eighty-six infants were included; 26 received ≤7 days and 60 received >7 days of antibiotics.
- No significant difference in recurrent UTI rates was observed between the two main treatment groups (p = 0.66).
- Subgroup analysis revealed a higher incidence of recurrent UTIs in infants treated for <7 days compared to 7 days (p = 0.03).
Conclusions:
- Antibiotic therapy duration (≤7 vs >7 days) did not significantly impact UTI recurrence in the overall NICU population.
- A higher percentage of patients with urinary tract anomalies experienced recurrent UTIs.
- Further investigation into optimal UTI treatment durations in neonates is warranted.
Objectives:
Urinary tract infection (UTI) is the most common bacterial infection in infants. Current practice guidelines suggest a treatment duration of 7 to 14 days. Suboptimal therapy may increase the risk for recurrent UTIs leading to renal scarring and possibly chronic kidney disease. The primary objective is to evaluate the duration of therapy for UTIs and its association with the incidence of recurrent UTIs in a neonatal intensive care unit (NICU). The secondary objectives are to identify the risk factors and the most common organisms for recurrent UTIs.
Methods:
Patients were identified via the diagnosis codes for UTIs and were included if admitted to the NICU and if they received antibiotics prior to hospital discharge. Patients were divided into 2 groups: antibiotic treatment for 7 days or fewer and antibiotic treatment for greater than 7 days.
Results:
Eighty-six infants were included in the study. Twenty-six patients received antibiotics for 7 days or fewer, and 60 for more than 7 days. In the study, the median birth weight was 977 g and the median gestational age was 27.6 weeks. There was no significant difference in the rate of recurrent UTIs between the 2 groups (p = 0.66). However, in the subgroup analysis, the incidence was higher for patients receiving antibiotic therapy for fewer than 7 days versus 7 days (p = 0.03).
Conclusion:
There was no difference in recurrence of UTI between treatment groups (≤7 days versus >7 days), and recurrence was seen in a higher percentage of patients with a urinary tract anomaly.
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