Duration of intravenous antibiotics and treatment failure in infants hospitalized with urinary tract infections

Autor: Brady, Patrick W.
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Druh dokumentu: Text
Popis: BACKGROUND. Urinary tract infections (UTIs) are common, and length of intravenous (IV) antibiotic therapy may vary in younger infants due to inadequate evidence on course necessary to prevent treatment failure.OBJECTIVE. To determine the difference between short- (=3 days) and long- (=4 days) duration IV antibiotic therapy on treatment failure in a cohort of young infants hospitalized with urinary tract infection. METHODS. We conducted a retrospective cohort study of infants less than 6 months of age hospitalized with an acute UTI between 1999 and 2004 at 24 children’s hospitals in the Pediatric Health Information System (PHIS). We characterized differences in treatment status and outcome at a patient and hospital level. Our main model adjusted for all covariates, propensity scores, and clustering by hospital to evaluate the effect of short versus long courses of IV antibiotics on treatment failure defined as readmission for UTI within 30 days. RESULTS. Of the 12,360 infants who met inclusion criteria, 240 (1.9%) experienced treatment failure. The treatment failure rate was 1.6% in children who received a short course of IV antibiotics and 2.2% in those that received a long course. Treatment course varied substantially across hospitals and with patient-level characteristics. After multivariable adjustment, including propensity scores, there was no significant association between treatment group and outcome with odds ratio for long treatment compared to short treatment of 0.90 (95% confidence interval of 0.68 to 1.19). Known presence of genitourinary abnormalities—but not age—predicted treatment failure in the final model.CONCLUSIONS. Treatment failure for infants less than 6 months hospitalized with UTI is uncommon and is not associated with duration of IV antibiotics. Treating more infants with short courses of IV antibiotics could potentially decrease the length of hospitalization without affecting the readmission rate.
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