Alan R Schroeder1, Mark W Shen2, Eric A Biondi3, Michael Bendel-Stenzel4, Clifford N Chen5, Jason French6, Vivian Lee7, Rianna C Evans8, Karen E Jerardi9, Matt Mischler10, Kelly E Wood11, Pearl W Chang12, Heidi K Roman13, Tara L Greenhow14. 1. Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California, USA Stanford University School of Medicine, Stanford, California, USA. 2. Department of Pediatrics, Dell Children's Medical Center, Austin, Texas, USA. 3. Department of Pediatrics, University of Rochester, Rochester, New York, USA. 4. Department of Pediatrics, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota, USA. 5. Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA. 6. Department of Pediatrics, Children's Hospital Colorado, Denver, Colorado, USA. 7. Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA. 8. Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA. 9. Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA. 10. Department of Pediatrics, Children's Hospital of Illinois, Peoria, Illinois, USA. 11. Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa, USA. 12. Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California, USA Stanford University School of Medicine, Stanford, California, USA Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, California, USA. 13. Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California, USA Stanford University School of Medicine, Stanford, California, USA Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA. 14. Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, California, USA.
Abstract
OBJECTIVES: To determine predictors of parenteral antibiotic duration and the association between parenteral treatment duration and relapses in infants <3 months with bacteraemic urinary tract infection (UTI). DESIGN: Multicentre retrospective cohort study. SETTING: Eleven healthcare institutions across the USA. PATIENTS: Infants <3 months of age with bacteraemic UTI, defined as the same pathogenic organism isolated from blood and urine. MAIN OUTCOME MEASURES: Duration of parenteral antibiotic therapy, relapsed UTI within 30 days. RESULTS: The mean (±SD) duration of parenteral antibiotics for the 251 included infants was 7.8 days (±4 days), with considerable variability between institutions (mean range 5.5-12 days). Independent predictors of the duration of parenteral antibiotic therapy included (coefficient, 95% CI): age (-0.2 days, -0.3 days to -0.08 days, for each week older), year treated (-0.2 days, -0.4 to -0.03 days for each subsequent calendar year), male gender (0.9 days, 0.01 to 1.8 days), a positive repeat blood culture during acute treatment (3.5 days, 1.2-5.9 days) and a non-Escherichia coli organism (2.2 days, 0.8-3.6 days). No infants had a relapsed bacteraemic UTI. Six infants (2.4%) had a relapsed UTI (without bacteraemia). The duration of parenteral antibiotics did not differ between infants with and without a relapse (8.2 vs 7.8 days, p=0.81). CONCLUSIONS: Parenteral antibiotic treatment duration in young infants with bacteraemic UTI was variable and only minimally explained by measurable patient factors. Relapses were rare and were not associated with treatment duration. Shorter parenteral courses may be appropriate in some infants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVES: To determine predictors of parenteral antibiotic duration and the association between parenteral treatment duration and relapses in infants <3 months with bacteraemic urinary tract infection (UTI). DESIGN: Multicentre retrospective cohort study. SETTING: Eleven healthcare institutions across the USA. PATIENTS: Infants <3 months of age with bacteraemic UTI, defined as the same pathogenic organism isolated from blood and urine. MAIN OUTCOME MEASURES: Duration of parenteral antibiotic therapy, relapsed UTI within 30 days. RESULTS: The mean (±SD) duration of parenteral antibiotics for the 251 included infants was 7.8 days (±4 days), with considerable variability between institutions (mean range 5.5-12 days). Independent predictors of the duration of parenteral antibiotic therapy included (coefficient, 95% CI): age (-0.2 days, -0.3 days to -0.08 days, for each week older), year treated (-0.2 days, -0.4 to -0.03 days for each subsequent calendar year), male gender (0.9 days, 0.01 to 1.8 days), a positive repeat blood culture during acute treatment (3.5 days, 1.2-5.9 days) and a non-Escherichia coli organism (2.2 days, 0.8-3.6 days). No infants had a relapsed bacteraemic UTI. Six infants (2.4%) had a relapsed UTI (without bacteraemia). The duration of parenteral antibiotics did not differ between infants with and without a relapse (8.2 vs 7.8 days, p=0.81). CONCLUSIONS: Parenteral antibiotic treatment duration in young infants with bacteraemic UTI was variable and only minimally explained by measurable patient factors. Relapses were rare and were not associated with treatment duration. Shorter parenteral courses may be appropriate in some infants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Keywords:
General Paediatrics; Infectious Diseases
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