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Short-course intravenous antibiotics for young infants with urinary tract infection
  1. Jolie Lawrence1,
  2. Laure F Pittet2,3,
  3. Samar Hikmat3,
  4. Eloise J Silvester2,4,
  5. Vanessa Clifford2,5,
  6. Rodney Hunt6,7,
  7. Amanda Gwee1,2
  1. 1 Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  2. 2 Infectious Diseases Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  3. 3 Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  5. 5 Laboratory Services, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  6. 6 Department of Paediatrics, Monash University, Clayton, Victoria, Australia
  7. 7 Monash Newborn, Monash Health, Clayton, Victoria, Australia
  1. Correspondence to Dr Jolie Lawrence, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; jolie.lawrence{at}rch.org.au

Abstract

Objective Shorter courses of intravenous antibiotics for young infants with urinary tract infection (UTI) have myriad advantages. As practice shifts toward shorter intravenous treatment courses, this study aimed to determine the safety of early intravenous-to-oral antibiotic switch and identify risk factors for bacteraemia with UTI.

Methods Retrospective audit of infants aged ≤90 days with a positive urine culture at a quaternary paediatric hospital over 4 years (2016–2020). Data were collected from the hospital electronic medical record and laboratory information system. Short-course intravenous antibiotic duration was defined as <48 hours for non-bacteraemic UTI and <7 days for bacteraemic UTI. Multivariate analysis was used to determine patient factors predicting bacteraemia.

Results Among 427 infants with non-bacteraemic UTI, 257 (60.2%) were treated for <48 hours. Clinicians prescribed shorter intravenous courses to infants who were female, aged >30 days, afebrile and those without bacteraemia or cerebrospinal fluid pleocytosis. Treatment failure (30-day UTI recurrence) occurred in 6/451 (1.3%) infants. All had non-bacteraemic UTI and one received <48 hours of intravenous antibiotics. None had serious complications (bacteraemia, meningitis, death). Follow-up audiology occurred in 21/31 (68%) infants with cerebrospinal fluid pleocytosis, and one had sensorineural hearing loss. Bacteraemia occurred in 24/451 (5.3%) infants, with 10 receiving <7 days intravenous antibiotics with no treatment failure. Fever and pyelonephritis were independent predictors of bacteraemia.

Conclusion Short-course intravenous antibiotics for <48 hours for young infants with non-bacteraemic UTI should be considered, provided meningitis has been excluded. Treatment failure and serious complications were rare in young infants with UTI.

  • paediatrics
  • infectious disease medicine

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Footnotes

  • Correction notice This article has been corrected since it was first published. There was an error with the typesetting of Table 1 with some rows duplicated. This has now been fixed.

  • Contributors JL conceptualised and designed the study, conducted a literature review, obtained ethics board approval, collected data, carried out the data analyses, drafted the initial manuscript, reviewed and revised the manuscript, and is guarantor for the study. SH conducted a literature review. LFP and EJS assisted with the data analyses. VC extracted the microbiological data, and reviewed and revised the manuscript. RH conceptualised and designed the study, and reviewed and revised the manuscript. AG conceptualised and designed the study, and reviewed and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.