Intravenous antibiotics for urinary tract infections in children with neurologic impairment

Abstract

BackgroundChildren with high‐intensity neurologic impairment (HINI) have an increased risk of urinary tract infection (UTI) and prolonged intravenous (IV) antibiotic exposure.ObjectiveTo determine the association between short (≤3 days) and long (>3 days) IV antibiotic courses and UTI treatment failure in hospitalized children with HINI.MethodsWe performed a retrospective cohort study examining UTI hospitalizations at 49 hospitals in the Pediatric Health Information System from 2016 to 2021 for children (1–18 years) with HINI. The primary outcome was UTI readmission within 30 days. Our secondary outcome was the association of hospital‐level variation in short IV antibiotic course use with readmission. Readmission rates were compared between short and long courses using multivariable regression.ResultsOf 5612 hospitalizations, 3840 (68.4%) had short IV antibiotic courses. In our adjusted model, children with short IV courses were less likely than with long courses to have a 30‐day UTI readmission (4.0%, 95% CI [3.6%, 4.5%] vs. 6.3%, 95% CI [5.1%, 7.8%]). Despite marked hospital‐level variation in short IV course use (50.0%–87.5% of hospitalizations), there was no correlation with readmissions.ConclusionsChildren with HINI hospitalized with UTI had low UTI readmission rates, but those who received long IV antibiotic courses were more likely to experience UTI readmission versus those receiving short courses. While residual confounding may influence our results, we did not find that short IV courses impacted readmission at the hospital level despite variation in use across institutions. Long IV antibiotic courses are associated with risks and may not confer benefit in this population.

Kidney and Pregnancy: A Comprehensive Review

“…In addition, the uterus, as it grows, can compress the bladder and urinary tract, causing incomplete emptying of the bladder and dilation of the ureters [ 11 ]. Proper hygiene and correct hydration are fundamental to preventing UTIs, while early detection and treatment are crucial to prevent complications [ 12 ]. Regular prenatal care, including urine screenings, can help ensure both the mother’s and baby’s health.…”

Kidney and Pregnancy: A Comprehensive Review

“…In addition, the uterus, as it grows, can compress the bladder and urinary tract, causing incomplete emptying of the bladder and dilation of the ureters [ 11 ]. Proper hygiene and correct hydration are fundamental to preventing UTIs, while early detection and treatment are crucial to prevent complications [ 12 ]. Regular prenatal care, including urine screenings, can help ensure both the mother’s and baby’s health.…”

Remaining diagnostic and treatment uncertainties for urinary tract infections in children with genitourinary anomalies

“…A NB is a significant risk factor for urinary tract infection (UTI), and thus many children with HINI suffer from UTIs. However, there is a lack of data to inform evidencebased recommendations for the treatment of UTIs within this population, a problem addressed in the article by Starnes et al 1 In this study, the authors use the Pediatric Health Information System database to compare the rate of treatment failure between children with HINI admitted with UTIs who are treated with long versus short courses of intravenous (IV) antibiotics. They found lower rates of treatment failure in children treated with short versus long courses of IV antibiotics (4.0% vs. 6.3%) in both the unadjusted and adjusted propensity score matched analyses.…”

Kidney and Pregnancy: A Comprehensive Review

“…In addition, the uterus, as it grows, can compress the bladder and urinary tract, causing incomplete emptying of the bladder and dilation of the ureters [ 11 ]. Proper hygiene and correct hydration are fundamental to preventing UTIs, while early detection and treatment are crucial to prevent complications [ 12 ]. Regular prenatal care, including urine screenings, can help ensure both the mother’s and baby’s health.…”

Remaining diagnostic and treatment uncertainties for urinary tract infections in children with genitourinary anomalies

“…A NB is a significant risk factor for urinary tract infection (UTI), and thus many children with HINI suffer from UTIs. However, there is a lack of data to inform evidencebased recommendations for the treatment of UTIs within this population, a problem addressed in the article by Starnes et al 1 In this study, the authors use the Pediatric Health Information System database to compare the rate of treatment failure between children with HINI admitted with UTIs who are treated with long versus short courses of intravenous (IV) antibiotics. They found lower rates of treatment failure in children treated with short versus long courses of IV antibiotics (4.0% vs. 6.3%) in both the unadjusted and adjusted propensity score matched analyses.…”

Kidney and Pregnancy: A Comprehensive Review

“…In addition, the uterus, as it grows, can compress the bladder and urinary tract, causing incomplete emptying of the bladder and dilation of the ureters [ 11 ]. Proper hygiene and correct hydration are fundamental to preventing UTIs, while early detection and treatment are crucial to prevent complications [ 12 ]. Regular prenatal care, including urine screenings, can help ensure both the mother’s and baby’s health.…”

Remaining diagnostic and treatment uncertainties for urinary tract infections in children with genitourinary anomalies

“…A NB is a significant risk factor for urinary tract infection (UTI), and thus many children with HINI suffer from UTIs. However, there is a lack of data to inform evidencebased recommendations for the treatment of UTIs within this population, a problem addressed in the article by Starnes et al 1 In this study, the authors use the Pediatric Health Information System database to compare the rate of treatment failure between children with HINI admitted with UTIs who are treated with long versus short courses of intravenous (IV) antibiotics. They found lower rates of treatment failure in children treated with short versus long courses of IV antibiotics (4.0% vs. 6.3%) in both the unadjusted and adjusted propensity score matched analyses.…”