Hospitalized children with high-intensity neurologic impairments undergo fewer readmissions for urinary tract infections when given an abbreviated course of intravenous antibiotics rather than longer-term treatment.
New research in the Journal of Hospital Medicine shows that a three-day or shorter course of IV antibiotics was less likely to result in treatment failure, defined as readmission for a urinary tract infection.
“We looked at a comparison of children with neurological impairment admitted for UTI who received three or fewer days of IV antibiotics versus those who received more than three days,” said senior investigator Katherine Freundlich, M.D., associate professor of clinical pediatrics at Monroe Carrell Jr. Children’s Hospital at Vanderbilt.
“The children treated with a shorter course were actually less likely to be readmitted within 30 days than those who received a longer course.”
Longer Not Better
The study involved a retrospective analysis of data collected at 49 children’s hospitals over a five-year period. The children studied were 1 to 18 years old and were hospitalized between 2016 and 2021.
“The primary outcome was treatment failure, defined as readmission to the hospital with a primary discharge diagnosis code for UTI within 30 days of discharge,” the authors wrote. One secondary outcome was 30-day all-cause readmission.
“We found that children treated with a shorter course were less likely to be readmitted within 30 days.”
Among a total of 5,612 hospitalizations, 3,840, or 68.4 percent, involved short course IV antibiotic treatment, while 1,772 were given a longer course. The analysis showed that 4.0 percent of children on the abbreviated courses experienced treatment failure compared to 6.3 percent of those on antibiotics for a longer term.
“Additionally, 18.9 percent of children who received short IV courses experienced all-cause 30-day readmission, compared to 22.6 percent of children who received long IV courses (p=.008).”
A Robust Finding
“Even after we adjusted for many potential factors that could influence differences between the two groups and which treatment was chosen, we found that children treated with a shorter course were less likely to be readmitted within 30 days,” Freundlich said.
“We also did a further analysis using propensity scoring to adjust for factors that might have influenced the treatment decisions made at the beginning. Propensity scoring is a statistical method that makes an observational study like ours more like the gold standard—a randomized controlled trial. The results held up.”
Among differences noted was that installation of a central line was required for a three day or longer course of IV antibiotics, which may raise the risk of blood clots and bloodstream infections, Freundlich said.
The authors acknowledged that IV antibiotics are needed in some cases for initial treatment of UTIs, but urged clinicians to “consider a rapid transition to oral antibiotics as early as safe and feasible.”
An Understudied Population
The study’s patient population included children with quadriplegic cerebral palsy, some with serious injuries from motor vehicle accidents, some with severe traumatic brain injuries, and those with complex genetic conditions affecting diverse organ systems.
“Clinically, in a lot of areas beyond UTIs, we have limited information on how to manage many medical problems that this group experiences.”
This group of patients has not been well studied.
“Clinically, in a lot of areas beyond UTIs, we have limited information on how to manage many medical problems that this group experiences,” Freundlich said.
Lacking Evidence on Best Approach
She and her co-authors embarked on the study of management of UTIs in hospitalized children with neurological impairment because no relevant practice guidelines have been written, she explained.
“This leaves people to make their own educated guesses as to how to best manage the problem,” she said.
Use of antibiotics for UTIs is only one of many vital questions that are being explored to improve their care for this group of patients.
“My next clinical question of interest is the management of lower respiratory tract infections in children with medical complexity,” Freundlich said.
