More physicians are choosing shorter intravenous antibiotic courses for infantile urinary tract infections

1. Proportion of children ≤60 days old receiving more than 4 days (long-course) of intravenous (IV) antibiotics for urinary tract infection (UTI) decreased from 2005 to 2015 without an associated increase in readmission rates.

2. Female sex, younger age, and non-Hispanic white ethnicity were associated with higher rates of 30-day readmission.

Evidence Level: 2 (Good)

Study Rundown: Rapid initiation of empiric IV antibiotics in infants ≤60 days old suspected of having a bacterial infection is common practice until the infectious source is determined, yet the optimal duration of IV antibiotic therapy once a UTI has been diagnosed is unknown. Current American Academy of Pediatric guidelines state oral and parental antibiotic treatment for UTIs in children 2 to 24 months of age are equally effective, but no guidelines exist for younger infants. This retrospective analysis looked at trends in duration of IV antibiotic therapy for UTI in infants ≤60 days of age. Results showed an overall decrease in the proportion of infants receiving longer courses (>3 calendar days) of antibiotics compared to shorter courses (≤3 calendar days) in 2005 compared to 2015; however, the variability between hospitals remained high. No significant difference in 30-day readmission rates (for both UTI and all-cause readmission) was found between infants who received short versus long antibiotic courses. Female sex and younger age were associated with higher rates of readmission. One limitation of this study was the inclusion of data on antibiotic duration from billing information, which may not reflect the actual medicine administration as accurately as the medication administration record. Furthermore, no information was collected related to factors that may predispose participants to more severe or persistent disease. Results from this study support the use of short-course IV antibiotic in infants ≤60 days old treated for UTI, which could also reduce length of hospitalization and therefore adverse outcomes and medical costs related to longer stays.

Click to read the study, published today in Pediatrics

Relevant reading: The changing epidemiology of serious bacterial infections in young infants

In-depth [retrospective cohort]: This study included data from 3973 infants ≤60 days old with a discharge diagnosis of UTI who received antibiotics within 2 days of admission to one of 46 children’s hospitals between 2005 and 2015. Researchers compared the proportion of children receiving short- versus long-course antibiotics per year, as well as patient readmissions within 30 days, both for UTIs specifically and for all-causes. Results showed that the overall percentage of patients receiving long-course IV antibiotics for UTI decreased from 50% in 2005 to 19% in 2015. Among hospitals who reported data at both the start and end of the study, there was a decrease in long-course IV therapy by 21%. In 2005, the proportion of patients receiving longer IV treatment ranged from 3% to 59% across hospitals, while it ranged from 0% to 67% across hospitals in 2015. There was no significant difference between patients treated with long- versus short-course IV therapy in UTI-related readmission rates (1.5% for both groups, odds ratio [OR] for long 0.93, 95%CI 0.52-1.67, p = 0.99) or all-cause readmission (5.0% and 4.1% respectively, OR for long 1.16, 95%CI 0.83-1.62, p = 0.21). Female sex was significantly associated with increased 30-day readmission for UTI (OR 1.91, 95%CI 1.09-3.33, p < .05). Infants <15 days old also had a significantly high risk of readmission for UTI (OR 2.48, 95%CI 1.13-5.44, p < .05) and of all-cause readmission (OR 1.79, 95%CI 1.09-2.92, p < .05). Non-Hispanic white infants were also had significantly higher rates of all-cause readmission (OR 2.78, 95%CI 1.38-5.60, p < .05).

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