Bacteremic UTI in Infants Can Be Managed With Shorter-Course Parenteral Antibiotics

By Reuters Staff

August 21, 2019

NEW YORK (Reuters Health) - Recurrent urinary-tract infections (UTIs) are no more frequent among infants with bacteremic UTI who receive shorter versus longer parenteral antibiotic treatment, according to a retrospective study.

An estimated 8% to 10% of young infants with UTI have concomitant bacteremia, and there are no evidence-based guidelines regarding the optimal duration of parenteral antibiotic therapy in these children.

For the study, Dr. Sanyukta Desai of the University of Cincinnati and Cincinnati Children's Hospital Medical Center, in Ohio, and colleagues looked at outcomes in 115 infants aged 60 days and younger with bacteremic UTI who presented to one of 11 geographically diverse children's hospitals.

The most common causative organism was Escherichia coli, found in 93 infants (81%).

The median duration of parenteral antibiotic therapy was seven days, with 23% of infants receiving 14 days, 16% receiving seven days and 11% receiving 10 days of parenteral antibiotic treatment.

Half the infants (58/115) received short-course (seven days or fewer) parenteral antibiotics, and half (57/115) received longer-duration parenteral antibiotics.

Recurrent UTI was diagnosed in six infants (5%), two of whom received short-course therapy and four of whom received long-course therapy, the researchers report in Pediatrics, online August 20.

Two of the six infants with recurrent UTI (both in the long-course treatment group) grew an organism distinct from the causative organism isolated at the index hospitalization.

During the 30 days after the index discharge, 15 infants (13%) experienced a hospital readmission or emergency department revisit, with no significant difference between the short- and long-course groups.

Mean hospital length of stay was six days longer in the long-course group than in the short-course group.

No infants in either group required ICU readmission, mechanical ventilation or vasopressor use, or showed signs of neurologic sequelae within 30 days of discharge from the original hospitalization.

"Our data indicates that 7 or fewer days of parenteral antibiotic therapy may be safe in this population," the authors conclude. "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."

Dr. Desai did not respond to a request for comments.


Pediatrics 2019.