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Bacteraemic urinary tract infection: management and outcomes in young infants
  1. Alan R Schroeder1,2,
  2. Mark W Shen3,
  3. Eric A Biondi4,
  4. Michael Bendel-Stenzel5,
  5. Clifford N Chen6,
  6. Jason French7,
  7. Vivian Lee8,
  8. Rianna C Evans9,
  9. Karen E Jerardi10,
  10. Matt Mischler11,
  11. Kelly E Wood12,
  12. Pearl W Chang1,2,13,
  13. Heidi K Roman1,2,6,
  14. Tara L Greenhow13
  1. 1Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California, USA
  2. 2Stanford University School of Medicine, Stanford, California, USA
  3. 3Department of Pediatrics, Dell Children's Medical Center, Austin, Texas, USA
  4. 4Department of Pediatrics, University of Rochester, Rochester, New York, USA
  5. 5Department of Pediatrics, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota, USA
  6. 6Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA
  7. 7Department of Pediatrics, Children's Hospital Colorado, Denver, Colorado, USA
  8. 8Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
  9. 9Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
  10. 10Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
  11. 11Department of Pediatrics, Children's Hospital of Illinois, Peoria, Illinois, USA
  12. 12Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa, USA
  13. 13Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, California, USA
  1. Correspondence to Dr Alan R Schroeder, Department of Pediatrics, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128, USA; Alan.Schroeder{at}hhs.sccgov.org

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.

  • General Paediatrics
  • Infectious Diseases

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