313 - Initial Short versus Long Course Intravenous Antibiotics for Neonatal Urinary Tract Infections

Poster Number: 313
Publication Number: 313.213

Alyssa M. Lear, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Rupal Patel, Levine Children's Hospital, Charlotte, NC, United States; Lee Morris, Atrium Health, Charlotte, NC, United States; Brittany Logston, Levine Children's Hospital, Charlotte, NC, United States; Jeanne B. Forrester, Levine Children's Hospital, Charlotte, NC, United States; Travis J. Carlson, High Point University, High Point, NC, United States; Rishi Laroia, Levine Children’s Hospital at Atrium Health, Charlotte, NC, United States

Background: Although studies have demonstrated safety of short course intravenous (IV) antibiotics with early conversion to oral therapy in older infants with urinary tract infections (UTIs), optimal duration of IV therapy in neonates (≤ 30 days) is less known.

Objective: This was a multicenter, retrospective cohort study including neonates hospitalized with UTI from 9/2015 - 8/2020 to determine the safety of early conversion to oral antibiotics. UTI was defined as >50,000 CFUs/mL of a single uropathogen or >10,000 CFUs/mL of a single uropathogen plus pyuria. Exclusion criteria included underlying chronic conditions, previous UTI, positive cultures from other sterile sites, admission to the intensive care unit (ICU), multidrug resistant UTI or planned antibiotic duration less than seven days.

Design/Methods: The cohort was stratified into two groups: neonates receiving short ( < 72 hours) or long course (>72 hours) IV antibiotics. The primary outcome was treatment failure, defined as UTI recurrence upon readmission or outpatient visit within 30 days.

Results: Fifty one and 22 neonates received short and long course IV antibiotics, respectively (Table 1). Escherichia coli was identified in 60 (82%) patients. Median duration of IV antibiotics was 2.3 and 4.6 days in the short and long groups, respectively (IQR 2.0-2.7 vs 3.4-6.6, p < 0.001). The median total duration (IV plus oral antibiotics; 10.0 vs 12.3 days, p=0.01) and hospital stay (2 vs 5 days, p < 0.001) were also shorter in the short course group. Treatment failure occurred in two neonates in the short course group (4% vs 0%, p=1.00), one of whom was readmitted (Table 2). Both neonates were diagnosed with vesicoureteral reflux and one had documented nonadherence to outpatient oral antibiotics. All-cause readmission within 30 days was greater in the short course group (8% vs 5%, p=1.00). There were no ICU admissions, mortality within 30 days, or peripherally inserted central catheter placements in either group. In a post hoc analysis, treatment failure remained similar in neonates receiving ≤48 hours of IV antibiotics compared to >48 hours (1/20; 5% vs 1/53; 2%, p=0.48).Conclusion(s): In hospitalized neonates with UTI, short courses of IV antibiotics did not result in a statistically significant increase in treatment failure and were associated with shorter hospital stays. Drawing conclusions from the two treatment failures, conservative therapy may be warranted in neonates with underlying urinary tract abnormalities or social circumstances worrisome for medication nonadherence. Although this is one of the largest studies investigating the optimal duration of IV therapy in neonates ≤ 30 days of age, it is possible that we were unable to detect a difference in treatment failure given our small sample size. Larger prospective studies are needed to verify these conclusions.
Table 1Baseline Characteristics
Table 2Patients Meeting Criteria for Treatment Failure