Predictors of Long Length of Stay in Infants Hospitalized With Urinary Tract Infection

Abstract

OBJECTIVE: Urinary tract infection (UTI) is the most common serious bacterial infection in infants. To use resources optimally, factors contributing to costs through length of stay (LOS) must be identifi ed. This study sought to identify clinical and health system factors associated with long LOS in infants with UTI. METHODS:Using a case-control design, we included infants <6 months old hospitalized with UTI. Cases had LOS ≥96 hours; controls had LOS <96 hours. Clinical and health system variables were extracted from medical records. Cases and controls were compared by using comparative statistics and multiple logistic regression analysis. RESULTS:Cases (n = 71) and controls (n = 71) did not differ by gender; cases were more likely to be younger (4.2 vs 7.1 weeks, P = .04), born preterm (13% vs 3%, P = .03), have known genitourinary disease (17% vs 4%, P = .01), an ultrasound (85% vs 68%, P = .02) or voiding cystourethrogram (VCUG) (61% vs 34%, P = .001) ordered, longer wait for VCUG (53 vs 27 hours, P = .002), consult requested (54% vs 10%, P < .001), and longer duration of intravenous (IV) antibiotics (125 vs 62 hours, P < .001). Multiple logistic regression demonstrated that cases were more likely to be premature (odds ratio [OR] 7.6), have known genitourinary disease (OR 7.3), and have VCUG ordered in the hospital (OR 4.5). CONCLUSIONS:Infants who are older, are born full term, have no genitourinary disease, receive shorter courses of IV antibiotics, and do not have a VCUG ordered have shorter stays and may be eligible for a short-stay unit. Earlier transition to oral antibiotics and delayed ordering of a VCUG may decrease LOS. Predictors of Long Length of Stay in Infants Hospitalized With Urinary Tract Infection (Continued on last page)Urinary tract infection (UTI) is the most common serious bacterial infection in young infants.1 Approximately 7% of girls and 2% of boys will have a UTI by 6 years of age.2 Although most UTIs can be managed effectively on an outpatient basis, infants are often hospitalized for treatment.3 UTI accounts for ∼8% of infant infectious disease hospitalizations and ∼2% of all pediatric hospitalizations.4,5 Although rates and duration of hospitalization for UTI have remained fairly constant over the past decade, hospital costs have risen by ∼34% and continue to impose a signifi cant fi nancial burden on the health care system. 5To use health care resources optimally and reduce costs wherever possible, it is important to identify factors contributing to costs through hospitalization. Previous studies using a large administrative database have investigated selected factors contributing to length of stay (LOS) for UTI and found that children who were younger, were hospitalized at an institution without clinical practice guidelines, www.hospitalpediatrics.org or received initial empiric antibiotic therapy to which the uropathogen was not susceptible had greater LOS.6,7 We sought to identify additional clinical and health system factors associated with long LOS in infants hospita...

Length of Stay and Complications Associated With Febrile Infants &lt;90 Days of Age Hospitalized in the United States, 2000–2012

“…31 Nonetheless, relatively few empirical data exist regarding predictors of LOS for young infants admitted for nonsurgical conditions. Others have reported that prematurity and concomitant comorbidities were associated with prolonged LOS for infants ,6 months of age with UTI, 32 and the specific infecting pathogen was associated with an increased LOS in children ,2 years of age with bronchiolitis. 33 We are not aware of any such study of infants and LOS, for any medical condition, performed on a large longitudinal data set such as we report here.…”

Short-course intravenous antibiotics for young infants with urinary tract infection

“…No serious complications were observed among 257 non-bacteraemic infants treated for <48 hours with intravenous antibiotics, and the overall risk of treatment failure was low (0.4%). All infants who experienced treatment failure had a risk factor such as prematurity, CAKUT or antibiotic resistance 31. Infants treated for <48 hours were predominantly female, aged >30 days, term, afebrile, with a CRP <20 mg/L and no CSF pleocytosis.…”