Short term antibiotics equally effective for bacteremic UTIs in infants

Written by Medha Baranwal Baranwal Published On 2019-08-25T19:25:23+05:30 | Updated On 25 Aug 2019 7:25 PM IST

USA: Short term course of parenteral antibiotics gives similar outcomes as compared to long-term in infants with bacteremic urinary tract infections (UTIs), finds a recent study.

According to the study, published in the AAP journal Pediatrics, 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-term parenteral antibiotic therapy is shown to be safe and equally effective in uncomplicated urinary tract infections (UTIs), short-term therapy safety in bacteremic UTI had not been established. Due to this infant with bacteremic UTI receive prolonged courses of parenteral antibiotics leading to increased costs and long hospitalization.

Sanyukta Desai, the University of Cincinnati and Cincinnati Children’s Hospital, and colleagues determined the association between parenteral antibiotic duration and outcomes in infants ≤60 days old with bacteremic urinary tract infection (UTI) in this multicenter, retrospective cohort study.

The researchers analyzed 115 infants aged 60 days or younger who were admitted to a group of 11 participating EDs between July 1, 2011, and June 30, 2016, if they had a UTI caused by a bacterial pathogen. Half of them were given parenteral antibiotics for 7 days or less before being switched to oral antibiotics, and the rest were given parenteral antibiotics for more than 7 days before switching to oral. Infants were more likely to receive long-term parenteral treatment if they were ill-appearing and had growth of a non–Escherichia coli organism.

Key findings include:

Six infants (two in the short-term group, four in the long-term group) had a recurrent UTI, each one diagnosed between 15 and 30 days after discharge; the adjusted risk difference between the two groups was 3%.

Two of the infants in the long-term group with a recurrent UTI had a different organism than during the index infection.

When comparing only the infants with the growth of the same pathogen that caused the index UTI, the adjusted risk difference between the two groups was 0.2%.

A total of 15 infants (6 in the short-term group, 9 in the long-term group) had 30-day all-cause reutilization, with no significant difference between groups (adjusted risk difference, 3%).

Mean length of stay was significantly longer in the long-term treatment group, compared with the short-term group (11 days vs. 5 days; adjusted mean difference, 6 days).

No infants experienced a serious adverse event such as ICU readmission, need for mechanical ventilation or vasopressor use, or signs of neurologic sequelae within 30 days of discharge from the index hospitalization, the investigators noted.

Peripherally inserted central catheters were required in 13 infants; of these, 1 infant had to revisit an ED because of a related mechanical complication.

"This study uniquely affords granularity with respect to the patient population, including a physician’s documented clinical assessment providing information such as temperature, ill appearance, or presence of a known genitourinary condition, which allowed for ascertainment of critical clinical information that influenced management decisions," Natalia V. Leva, MD, and Hillary L. Copp, the University of California, San Francisco, wrote in an accompanying editorial.

“Researchers in future prospective studies should seek to establish the bioavailability and optimal dosing of oral antibiotics in young infants and assess if there are particular subpopulations of infants with bacteremic UTI who may benefit from longer courses of parenteral antibiotic therapy," concluded the authors.

The bottom line of the study is -- Short-course parenteral therapy with early conversion to oral antibiotics may be considered in infants with bacteremic UTI.

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Source : Press Release

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Medha Baranwal Baranwal