Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections

ON BEHALF OF THE FEBRILE YOUNG INFANT RESEARCH COLLABORATIVE

Research output: Contribution to journalArticle

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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: 25.8 to 12.7) or 30-day all-cause reutilization (risk difference: 3%; 95% confidence interval: 214.5 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.

Original languageEnglish (US)
Article numbere20183844
JournalPediatrics
Volume144
Issue number3
DOIs
StatePublished - Jan 1 2019

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Urinary Tract Infections
Anti-Bacterial Agents
Therapeutics
Confidence Intervals
Recurrence
Propensity Score
Structural Models
Growth
Population
Length of Stay
Cohort Studies
Retrospective Studies
Urine

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections. / ON BEHALF OF THE FEBRILE YOUNG INFANT RESEARCH COLLABORATIVE.

In: Pediatrics, Vol. 144, No. 3, e20183844, 01.01.2019.

Research output: Contribution to journalArticle

ON BEHALF OF THE FEBRILE YOUNG INFANT RESEARCH COLLABORATIVE 2019, 'Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections', Pediatrics, vol. 144, no. 3, e20183844. https://doi.org/10.1542/peds.2018-3844
ON BEHALF OF THE FEBRILE YOUNG INFANT RESEARCH COLLABORATIVE. Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections. Pediatrics. 2019 Jan 1;144(3). e20183844. https://doi.org/10.1542/peds.2018-3844
ON BEHALF OF THE FEBRILE YOUNG INFANT RESEARCH COLLABORATIVE. / Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections. In: Pediatrics. 2019 ; Vol. 144, No. 3.
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title = "Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections",
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: 25.8 to 12.7) or 30-day all-cause reutilization (risk difference: 3{\%}; 95{\%} confidence interval: 214.5 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.",
author = "{ON BEHALF OF THE FEBRILE YOUNG INFANT RESEARCH COLLABORATIVE} and Sanyukta Desai and Aronson, {Paul L.} and Veronika Shabanova and Neuman, {Mark I.} and Frances Balamuth and Pruitt, {Christopher M.} and DePorre, {Adrienne G.} and Nigrovic, {Lise E.} and Rooholamini, {Sahar N.} and Wang, {Marie E.} and Marble, {Richard D.} and Williams, {Derek J.} and Laura Sartori and Leazer, {Rianna C.} and Christine Mitchell and Shah, {Samir S.} and Alpern, {Elizabeth R.} and Browning, {Whitney L.} and Feldman, {Elana A.} and Lumb, {Catherine E.} and McCulloh, {Russell J.} and Nipam Shah and Shin, {Sarah J.} and Christopher Woll",
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AU - ON BEHALF OF THE FEBRILE YOUNG INFANT RESEARCH COLLABORATIVE

AU - Desai, Sanyukta

AU - Aronson, Paul L.

AU - Shabanova, Veronika

AU - Neuman, Mark I.

AU - Balamuth, Frances

AU - Pruitt, Christopher M.

AU - DePorre, Adrienne G.

AU - Nigrovic, Lise E.

AU - Rooholamini, Sahar N.

AU - Wang, Marie E.

AU - Marble, Richard D.

AU - Williams, Derek J.

AU - Sartori, Laura

AU - Leazer, Rianna C.

AU - Mitchell, Christine

AU - Shah, Samir S.

AU - Alpern, Elizabeth R.

AU - Browning, Whitney L.

AU - Feldman, Elana A.

AU - Lumb, Catherine E.

AU - McCulloh, Russell J.

AU - Shah, Nipam

AU - Shin, Sarah J.

AU - Woll, Christopher

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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: 25.8 to 12.7) or 30-day all-cause reutilization (risk difference: 3%; 95% confidence interval: 214.5 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.

AB - 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: 25.8 to 12.7) or 30-day all-cause reutilization (risk difference: 3%; 95% confidence interval: 214.5 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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DO - 10.1542/peds.2018-3844

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