Bacteraemic urinary tract infection: management and outcomes in young infants

Schroeder, Alan R.; Shen, Min; Biondi, Eric; Bendel-Stenzel, Michael; Chen, Clifford; French, Jason; Lee, Vivian; Evans, Rianna; Jerardi, Karen; Mischler, Matt; Wood, Kelly E.; Chang, Pearl W.; Román, H; Greenhow, Tara L.

doi:10.1136/archdischild-2014-307997

Cited by 47 publications

(52 citation statements)

References 26 publications

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“…While the risk of bacteremia secondary to UTI remains substantial, it is unlikely to be associated with adverse effects, and recent studies on well‐appearing infants with bacteremia secondary to UTI show similar clinical outcomes between those treated with a prolonged course of parenteral antibiotics vs. those treated with shorter courses of parenteral antibiotics [17, 30, 31]. …”

Section: Epidemiology Of Infections In Febrile Infantsmentioning

confidence: 99%

Facing the ongoing challenge of the febrile young infant

2017

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Section: Epidemiology Of Infections In Febrile Infantsmentioning

confidence: 99%

Facing the ongoing challenge of the febrile young infant

2017

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“…The prevalence of bacteremia in infants ≤60 days old with UTIs was 9% in a study conducted from 2008 to 2013 in 26 EDs and has ranged from 3% to 17% in older studies. 10,22 Many studies have described similar clinical and laboratory findings in young infants with bacteremic and nonbacteremic UTIs. [39][40][41] Despite this, bacteremic UTIs have been associated with prolonged parenteral antibiotic courses, resulting in longer hospitalizations and increased costs.…”

Section: Special Considerations Bacteremic Utimentioning

confidence: 94%

“…[39][40][41] Despite this, bacteremic UTIs have been associated with prolonged parenteral antibiotic courses, resulting in longer hospitalizations and increased costs. 40 Two recent multicenter studies of infants with bacteremic UTIs (251 infants <3 months old 22 and 115 infants ≤60 days old 42 ) demonstrated variable IV courses and no association between IV duration and relapsed UTI. The latter study showed no risk difference in the adjusted 30-day UTI recurrence (risk difference 3%, 95% CI: −5.8 to 12.7) or allcause reutilization (risk difference 3%, 95% CI: −14.5 to 20.6) between long and short IV groups.…”

Section: Special Considerations Bacteremic Utimentioning

confidence: 99%

“…Six infants (2.4%) had a relapsed UTI without bacteremia, with no association between IV antibiotic duration and relapse. 22 Based on the available data and known risks of hospitalization and prolonged IV therapy, a reasonable approach for infants <1 month old would be to hospitalize for two to three days while awaiting blood and cerebral spinal fluid (CSF) culture results. Given the possibility of Enterococcus or Enterobacteriaceae that are resistant to third-generation cephalosporins, standard therapy of ampicillin and gentamicin for febrile neonates is reasonable, assuming there is no concern for meningitis.…”

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confidence: 99%

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Diagnosis and Management of UTI in Febrile Infants Age 0–2 Months: Applicability of the AAP Guideline

Chang

Wang

Schroeder

2020

Journal of Hospital Medicine

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U rinary tract infections (UTIs) are the most common bacterial infection and one of the most common reasons for hospitalization in young infants. 1,2 The American Academy of Pediatrics (AAP) has published several clinical practice guidelines for the evaluation and management of febrile children ages 2-24 months with first-time UTIs, most recently in 2011 and affirmed in 2016. 3 These guidelines do not provide recommendations for infants aged <2 months, which leads to uncertainty regarding the diagnosis and management of UTIs for infants in this age group. We assess the applicability of the AAP UTI Guideline's action statements for infants aged <2 months presenting with first-time UTIs, with an emphasis on recent evidence. Because the considerations for bacterial infections differ for febrile infants aged <2 months compared with older infants, we do not discuss action statements one and two (determination of the likelihood of UTIs and decision to test urine) and statement seven (medical evaluation for fever after first UTI). 3 Additionally, because concomitant bacteremia and meningitis are more common in this age group than in older infants, we review some of the controversies surrounding the diagnosis and treatment of these disease entities. DIAGNOSIS"Action Statement 3: To establish the diagnosis of UTI, clinicians should require both urinalysis results that suggest infection (pyuria and/or bacteriuria) and the presence of at least 50,000 colony-forming units (CFUs) per mL of a uropathogen cultured from a urine specimen obtained through catheterization or SPA." 3 To distinguish asymptomatic bacteriuria or contamination from a true UTI, the AAP Guideline requires both a positive urinalysis (UA) and culture for a diagnosis of a UTI. 3 Historically, the UA was considered to be poorly sensitive for infections in young infants, with older studies reporting sensitivities ranging from 40% to 82% using urine culture as the gold standard. 4-7 Thus, infants aged <2 months with positive urine cultures and negative UAs are often treated as having true UTIs, though this practice varies by institution. 8 Possible explanations for the low UA sensitivity in this population include rapid bladder emptying, immature immune systems, and inability to concentrate urine. However, a negative UA plus a positive urine culture could also represent a "true negative" UA and a "false positive" culture, a finding that may be more common in young infants in whom sterile urine obtainment is often challenging.Two recent studies have addressed this issue by evaluating the UA sensitivity in patients with bacteremic UTIs, as growth of the same pathogenic organism from the blood and urine almost certainly represents true infection. 9,10 In a retrospective study of 203 infants aged <3 months with bacteremic UTIs, the presence of any leukocyte esterase (LE) or pyuria (>3 white blood cells per high-powered field [WBC/HPF]) had a sensitivity of 99.5% (95% CI: 98.5%-100%) and specificity of 93.9% (95% CI: 87.8%-93.2%). 9 In a prospective, multicenter stu...

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“…The linked study by Schroeder et al 4 shows marked variation in the duration of parenteral antibiotics given by paediatricians to treat infants with bacteraemic UTIs in 11 US centres. The duration of parenteral antibiotics mostly seemed to depend on local practice, with each institution having a different mean duration (5, 7, 10 or 12 days).…”

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confidence: 99%