Nationwide Children's Hospital, Columbus, Ohio;
Nationwide Children's Hospital, Columbus, Ohio.
Hosp Pediatr. 2020 Sep;10(9):743-749. doi: 10.1542/hpeds.2019-0325. Epub 2020 Aug 17.
To describe practice patterns of intravenous (IV) antibiotic treatment duration in term neonates ≤28 days old with a urinary tract infection (UTI).
We performed a retrospective chart review of term neonates ≤28 days old hospitalized for UTI at 2 academic pediatric hospitals from 2012 to 2018. Neonates who were admitted to the PICU or with known preexisting renal and/or urologic anomalies or concomitant bacteremia were excluded. We examined clinical features, complications, and duration of IV antibiotic therapy. Univariate and multivariate analyses of long duration of IV antibiotics (>48 hours) were performed by using logistic regression.
Of 310 neonates identified by diagnostic codes and chart review, 112 met criteria for inclusion. The median IV antibiotic duration was 49 hours (51% received IV antibiotics for >48 hours), and the median total antibiotic duration was 10 days. No demographic features or laboratory values correlated with IV antibiotic duration apart from age <7 days. The odds of long IV antibiotic duration increased if the neonate had a secondary diagnosis extending hospitalization (adjusted odds ratio [aOR] = 3.2; = .002; 95% confidence interval [CI], 1.2-8.7), subspecialty consult (aOR = 4.79; < .001; 95% CI, 1.87-12.3), or an abnormal renal ultrasound (aOR = 2.26; = .02; 95% CI, 1.01-5.08). Only 1 neonate experienced treatment failure.
Our study revealed the recent trend toward shorter IV antibiotic courses for healthy term neonates with UTI is inclusive of infants ≤28 days at these 2 sites. Few factors associated with neonates' initial clinical presentation appear to influence the length of IV antibiotic treatment.
描述 28 天内患有尿路感染（UTI）的足月新生儿（<28 天）静脉（IV）抗生素治疗持续时间的实践模式。
我们对 2012 年至 2018 年在 2 所学术儿科医院住院治疗 UTI 的<28 天足月新生儿进行了回顾性图表审查。排除入住 PICU 或已知存在先天肾脏和/或泌尿系统异常或同时伴有菌血症的新生儿。我们检查了临床特征、并发症和 IV 抗生素治疗持续时间。使用逻辑回归对 IV 抗生素治疗时间过长（>48 小时）进行单变量和多变量分析。
通过诊断代码和图表审查确定了 310 名新生儿，其中 112 名符合纳入标准。IV 抗生素治疗持续时间中位数为 49 小时（51%接受 IV 抗生素治疗>48 小时），总抗生素治疗持续时间中位数为 10 天。除年龄<7 天外，无任何人口统计学特征或实验室值与 IV 抗生素持续时间相关。如果新生儿有延长住院时间的次要诊断（调整后的优势比[aOR] = 3.2；<.001；95%置信区间[CI]，1.2-8.7）、专科会诊（aOR = 4.79；<.001；95% CI，1.87-12.3）或异常肾脏超声（aOR = 2.26；<.02；95% CI，1.01-5.08），则长 IV 抗生素治疗的可能性增加。只有 1 名新生儿发生治疗失败。
我们的研究表明，最近的趋势是在这 2 个地点，对患有 UTI 的健康足月新生儿缩短 IV 抗生素疗程，包括≤28 天的婴儿。很少有与新生儿初始临床表现相关的因素似乎会影响 IV 抗生素治疗的长度。
