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Short-course parenteral antibiotics effective for bacteremic UTI in infants

Research published in Pediatrics suggests that infants aged 60 days and younger with bacteremic UTI could receive shorter courses of parenteral antibiotics without the risk for readmission or recurrent infection.

“Although several studies have supported the safety of short-course parenteral antibiotic therapy with early conversion to oral antibiotics in young infants with uncomplicated UTI, the safety of short-course parenteral antibiotic therapy in young infants with bacteremic UTI has not been established,” study researcher Sanyukta Desai, MD, from the division of hospital medicine at the University of Cincinnati College of Medicine, and colleagues wrote. “As a result, infants with bacteremic UTI often received prolonged courses of parenteral antibiotics, which can lead to long hospitalizations and increased costs.”

The researchers conducted a retrospective cohort study using patient data collected from 11 children’s hospitals between 2011 and 2016 on infants aged no older than 60 days. They included infants diagnosed with a UTI who had the same bacterial pathogen in both blood and urine cultures, according to the study. Desai and colleagues defined short-course parenteral antimicrobial therapy as 7 or fewer days of treatment, and long-course therapy as more than 7 days.

Half of the 115 infants treated for bacteremic UTI received short-course parenteral antibiotics. The researchers reported that infants receiving longer courses of parenteral antibiotics were more likely to be ill appearing. They also were more likely to be infected with bacteria other than Escherichia coli.

Infants receiving both short- and long-term parenteral antimicrobial therapy had similar risk for recurrent UTI after 30 days (adjusted risk difference = 3%; 95% CI, –5.8 to 12.7). Infants receiving either length of therapy also had comparable use of health care for any reason within 30 days (risk difference = 3%; 95% CI, –14.5 to 20.6).

“Our data [indicate] that 7 or fewer days of parenteral antibiotic therapy may be safe in this population,” Desai and colleagues wrote. “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.”

In a related editorial, Natalia V. Leva, MD, and Hillary L. Copp, MD, MS, from the University of California, San Francisco, wrote that although many clinicians tend to begin treatment of young infants with parenteral antibiotics, it remains unclear whether their prolonged use is beneficial.

“In young children who are fragile and often are on the precipice of severe consequences from infection, we are hesitant to risk any chance that they could acutely worsen if started on oral antibiotics and bioavailability becomes suboptimal,” they wrote.

The authors added that there are no recommendations on the duration of parenteral treatment of bacteremia with parenteral antibiotics. However, Desai and colleagues’ findings “provide further evidence that a short course of parenteral antibiotics in infants aged 60 days and younger with bacteremic UTI is safe and effective,” according to the editorial. – by Katherine Bortz

References:

Desai S, et al. Pediatrics. 2019;doi:10.1542/pediatrics.2018-3844.

Leva NV, Copp HP. Pediatrics. 2019;doi:10;1542/pediatrics.2019-1611.

Disclosures: The authors report no relevant financial disclosures.