Sanyukta Desai1, Paul L Aronson2,3,4, Veronika Shabanova2,5, Mark I Neuman6, Frances Balamuth7,8, Christopher M Pruitt9, Adrienne G DePorre10, Lise E Nigrovic6, Sahar N Rooholamini11, Marie E Wang12, Richard D Marble13, Derek J Williams14, Laura Sartori15, Rianna C Leazer16, Christine Mitchell7, Samir S Shah14,17. 1. Divisions of Hospital Medicine and sanyukta.desai86@gmail.com. 2. Departments of Pediatrics and. 3. Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut. 4. Sections of Pediatric Emergency Medicine and. 5. General Pediatrics and. 6. Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts. 7. Division of Emergency Medicine and. 8. Center for Pediatric Clinical Effectiveness, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 9. Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. 10. Division of Hospital Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri. 11. Division of Hospital Medicine, Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington. 12. Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children's Hospital Stanford, Palo Alto, California. 13. Division of Emergency Medicine, Feinberg School of Medicine, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. 14. Divisions of Hospital Medicine and. 15. Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, Vanderbilt University and Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; and. 16. Division of Hospital Medicine, Department of Pediatrics, Children's Hospital of The King's Daughters, Norfolk, Virginia. 17. Infectious Diseases, Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Abstract
OBJECTIVES: To determine the association between parenteral antibiotic duration and outcomes in infants ≤60 days old with bacteremic urinary tract infection (UTI). METHODS: This multicenter retrospective cohort study included infants ≤60 days old who had concomitant growth of a pathogen in blood and urine cultures at 11 children's hospitals between 2011 and 2016. Short-course parenteral antibiotic duration was defined as ≤7 days, and long-course parenteral antibiotic duration was defined as >7 days. Propensity scores, calculated using patient characteristics, were used to determine the likelihood of receiving long-course parenteral antibiotics. We conducted inverse probability weighting to achieve covariate balance and applied marginal structural models to the weighted population to examine the association between parenteral antibiotic duration and outcomes (30-day UTI recurrence, 30-day all-cause reutilization, and length of stay). RESULTS: Among 115 infants with bacteremic UTI, 58 (50%) infants received short-course parenteral antibiotics. Infants who received long-course parenteral antibiotics were more likely to be ill appearing and have growth of a non-Escherichia coli organism. There was no difference in adjusted 30-day UTI recurrence between the long- and short-course groups (adjusted risk difference: 3%; 95% confidence interval: -5.8 to 12.7) or 30-day all-cause reutilization (risk difference: 3%; 95% confidence interval: -14.5 to 20.6). CONCLUSIONS: Young infants with bacteremic UTI who received ≤7 days of parenteral antibiotics did not have more frequent recurrent UTIs or hospital reutilization compared with infants who received long-course therapy. Short-course parenteral therapy with early conversion to oral antibiotics may be considered in this population.
OBJECTIVES: To determine the association between parenteral antibiotic duration and outcomes in infants ≤60 days old with bacteremic urinary tract infection (UTI). METHODS: This multicenter retrospective cohort study included infants ≤60 days old who had concomitant growth of a pathogen in blood and urine cultures at 11 children's hospitals between 2011 and 2016. Short-course parenteral antibiotic duration was defined as ≤7 days, and long-course parenteral antibiotic duration was defined as >7 days. Propensity scores, calculated using patient characteristics, were used to determine the likelihood of receiving long-course parenteral antibiotics. We conducted inverse probability weighting to achieve covariate balance and applied marginal structural models to the weighted population to examine the association between parenteral antibiotic duration and outcomes (30-day UTI recurrence, 30-day all-cause reutilization, and length of stay). RESULTS: Among 115 infants with bacteremic UTI, 58 (50%) infants received short-course parenteral antibiotics. Infants who received long-course parenteral antibiotics were more likely to be ill appearing and have growth of a non-Escherichia coli organism. There was no difference in adjusted 30-day UTI recurrence between the long- and short-course groups (adjusted risk difference: 3%; 95% confidence interval: -5.8 to 12.7) or 30-day all-cause reutilization (risk difference: 3%; 95% confidence interval: -14.5 to 20.6). CONCLUSIONS: Young infants with bacteremic UTI who received ≤7 days of parenteral antibiotics did not have more frequent recurrent UTIs or hospital reutilization compared with infants who received long-course therapy. Short-course parenteral therapy with early conversion to oral antibiotics may be considered in this population.
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