The impact of obesity on pediatric inpatients with urinary tract infections in the United States

Nationwide epidemiology and clinical practice patterns of pediatric urinary tract infections: application of multivariate time-series clustering

BACKGROUND

The nationwide epidemiology and clinical practice patterns for younger children hospitalized with urinary tract infections (UTIs) were unclear.

METHODS

We conducted a retrospective observational study consisting of 32,653 children aged < 36 months who were hospitalized with UTIs from 856 medical facilities during fiscal years 2011-2018 using a nationally representative inpatient database in Japan. We investigated the epidemiology of UTIs and changes in clinical practice patterns (e.g., antibiotic use) over 8 years. A machine learning algorithm of multivariate time-series clustering with dynamic time warping was used to classify the hospitals based on antibiotic use for UTIs.

RESULTS

We observed marked male predominance among children aged < 6 months, slight female predominance among children aged > 12 months, and summer seasonality among children hospitalized with UTIs. Most physicians selected intravenous second- or third-generation cephalosporins as the empiric therapy for treating UTIs, which was switched to oral antibiotics during hospitalizations for 80% of inpatients. Whereas total antibiotic use was constant over the 8 years, broad-spectrum antibiotic use decreased gradually from 5.4 in 2011 to 2.5 days of therapy per 100 patient-days in 2018. The time-series clustering distinctively classified 5 clusters of hospitals based on antibiotic use patterns and identified hospital clusters that preferred to use broad-spectrum antibiotics (e.g., antipseudomonal penicillin and carbapenem).

CONCLUSIONS

Our study provided novel insight into the epidemiology and practice patterns for pediatric UTIs. Time-series clustering can be useful to identify the hospitals with aberrant practice patterns to further promote antimicrobial stewardship. A higher resolution version of the Graphical abstract is available as Supplementary information.

Inpatient medical management of severe pediatric obesity: Literature review and case reports

Pediatric obesity rates continue to rise steeply with significant adverse effects on health outcomes across the lifespan. Significant obesity can affect the efficacy, side effects, and ability to use certain treatment, medication, or imaging modalities needed in the evaluation and management of acute pediatric conditions. Inpatient settings are rarely used as an opportunity for weight counseling and thus there is a paucity of clinical guidelines on how to manage severe obesity in the inpatient setting. We present a literature review and three patient cases with single-center protocol for non-surgical management of severe obesity in children admitted for other acute medical reasons. We performed a PubMed review from January 2002 to February 2022 utilizing keywords: "inpatient," "obesity," and "intervention." For our cases, we identified three patients with severe obesity acutely impacting their health while admitted for medical treatment who concurrently underwent acute, inpatient, weight loss regimens at a single children's hospital. The literature search yielded 33 articles describing inpatient weight loss treatments. Three patients met case criteria, all three of which demonstrated a decrease in their weight in excess percent of the 95th percentile after inpatient weight-management protocol implementation (% reduction BMI_p95: 16%-30%). This highlights obesity acutely limits or impacts specific medical care required during inpatient admissions in pediatric patients. It also suggests that implementation of an inpatient weight-management protocol during admission may provide an opportune setting to support acute weight loss and overall improved health outcomes in this high-risk cohort.

Clinical Outcome and Antibiotic Dosing Differences by Weight in Children With Acute Osteomyelitis

OBJECTIVES

To evaluate for weight-based differences in clinical outcomes and antibiotic dosing variability for children hospitalized with acute hematogenous osteomyelitis (AHO).

METHODS

We performed a retrospective cohort study of children aged 2 to 17 years and hospitalized with a primary AHO International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision diagnosis code between 2010 and 2017 using the Cerner Health Facts database. Weight categories (healthy, overweight, obesity) were determined by using Centers for Disease Control and Prevention age- and sex-specific BMI percentiles. Rates of procedures, complications, and length of stay (LOS) were compared between groups. Dosing variability between groups was assessed by comparing the initial milligrams per kilogram per day of prescribed antibiotics.

RESULTS

We identified 755 children with AHO for inclusion. Children with overweight and obesity were more likely to undergo surgical procedures (19% and 17%, respectively) compared with children with a healthy weight (10%; P = .009). They also had a longer LOS (5.7 and 5.8 days) than children with a healthy weight (4.9 days; P = .03). There were no differences in complication rates between weight categories. Mean weight-adjusted daily dose for the most frequently prescribed antibiotics was different by weight category, with children in higher weight categories more likely to receive lower weight-based doses.

CONCLUSIONS

Children with overweight and obesity hospitalized for AHO were more likely to undergo procedures, have longer LOS, and receive lower weight-based antibiotic dosing compared with children with a healthy weight. Our findings suggest that weight should be carefully considered when treating children with AHO.

A retrospective case-control cohort analysis of comorbidity and health expenditure in hospitalized adults diagnosed with obesity utilizing ICD-10 diagnostic coding

The cost and comorbidity of obesity in hospitalized inpatients, is less known. A retrospective study of patients presenting to a large district hospital in Western Sydney (April 2016-February 2017) using clinical, pathological as well as diagnostic coding data for obesity as per ICD-10. Of 43 212 consecutive hospital presentations, 390 had an obesity-coded diagnosis (Ob, 0.90%), of which 244 were gender and age-matched to a non-obesity coded cohort (NOb). Weight and BMI were higher in the Ob vs NOb group (126 ± 37 vs 82 ± 25 kg; BMI 46 ± 12 vs 29 ± 8 kg/m² , P < .001) with a medical record documentation rate of 62% for obesity among Ob. The Ob cohort had 2-5× higher rates of cardiopulmonary and metabolic complications (P < .001), greater pharmacologic burden, length of stay (LOS, 225 vs 89 hours, P < .001) and stay in intensive care but no differences in the prevalence of mental disorders. Compared with BMI <35 kg/m² , inpatients with BMI >35 kg/m² were 5× more likely to require intensive care (OR 5.08 [1.43-27.3, 95% CI], P = .0047). The initiation of obesity-specific interventions by clinical teams was very low. People with obesity who are admitted to hospital carry significant cost and complications, yet obesity is seldom recognized as a clinical entity or contributor.

Impact of Obesity on Urinary Tract Infections in Korean Adults: Secondary Data Analysis Using Community-Based Cohort Study

PURPOSE

This study investigated the incidence of urinary tract infection (UTI) in community-dwelling adults and identified the association between obesity and UTI.

METHODS

The participants were 4,926 adults aged over 40 years who had no UTIs at the baseline survey of the Korean Genome Epidemiology Study. Obesity was defined according to the cirtieria of Korean Society for the Study of Obesity using body mass index (BMI) data. UTI was defined as those who had self-reported UTI or had either nitrite, or both leukocytes and blood in the urine dipstick test. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using a multivariate Cox proportional hazards regression analysis to identify the association between the obesity and UTI.

RESULTS

The incidence proportion of UTI was 5.1%, and the incidence density per 1,000 person-years was 25.5. After controlling general characteristics, people with BMI ≥30.0 kg/m² remained 1.66 times (HR = 1.66, 95% CI = 1.06~2.60; p < .05) more likely to have UTI than those with normal weight. This trend was also present in men or people aged ≥ 60 years. Among women aged ≥ 60 years, people with BMI ≥ 30.0 kg/m² were 1.98 times (HR = 1.98, 95% CI = 1.01~3.86; p < .05) more likely to have UTI than those with normal weight.

CONCLUSION

The BMI ≥ 30.0 kg/m² is a risk factor of UTIs in Korean adult men over 40 years and women aged ≥ 60 years. It is necessary to emphasize the importance of obesity management to men or women aged ≥ 60 years, specifically.

Serial cross-sectional study for the association between urinary bisphenol A and paediatric obesity: Recent updates using NHANES 2003-2014

BACKGROUND

Several studies have reported bisphenol A (BPA) as a potential risk factor for paediatric obesity, but the findings were inconsistent among these studies.

METHODS

Using data from the National Health and Nutrition Examination Survey from 2003 to 2014, we conducted a serial cross-sectional study to examine the association between urinary BPA and paediatric obesity among children aged 6 and 19 years. The association between paediatric obesity and urinary BPA concentrations with or without urinary creatinine adjustments was assessed using multivariable regression and cubic spline models fitted for regression models.

RESULTS

We observed decreasing trends in urinary BPA concentrations from 2003 to 2014. The associations between urinary BPA concentrations and obesity were inconsistent across the years of survey and even after different models for urinary creatinine adjustments were used. Children with obesity were positively associated with urinary creatinine concentrations, but was not with creatinine-adjusted models. Furthermore, children with higher urinary BPA concentrations had elevated odds of obesity during 2003 to 2008, whereas these associations were inconsistent during 2009 to 2014.

CONCLUSIONS

The associations between paediatric obesity and urinary BPA concentrations differed across the years of survey and creatinine adjustments. Further studies are required to assess these discrepancies.

National survey of factors associated with repeated admissions due to febrile seizure

PURPOSE

Several studies reported recent trends in febrile seizure (FS) in terms of prevalence, incidence, and hospitalization rates at a national level in the USA. However, no studies have revealed risk factors for repeated admissions due to FS.

METHOD

We extracted discharge records of patients with FS aged < 6 years for the years 2010-14 using the Nationwide Readmission. Data were weighted to estimate the readmission rates and ascertain the factors associated with readmission due to FS, using multivariable negative binomial regression and Cox proportional hazard models.

RESULTS

The readmission rate of FS is approximately 3.45 cases per 1000 person-months after hospital discharge. Children aged 1-3 years had elevated rate of FS readmission with a peak age of 2 (adjusted IRR, 5.09; 95%CI, 2.25-11.5). Boys had 1.75 times higher rates of FS readmission than girls (95%CI, 1.13-2.70). Children with very-low income levels were more likely to be readmitted, compared to those with very-high income levels (adjusted IRR, 2.57; 95%CI, 1.39-4.76).

CONCLUSIONS

We provided novel insights into the current epidemiology of children with FS and risk factors associated with FS readmissions.

Dose-dependent relationships between weight status and clinical outcomes among infants hospitalized with respiratory syncytial virus infections

BACKGROUND

Associations between weight status and manifestations of respiratory syncytial virus infections remain unclear, especially in infants.

OBJECTIVE

This study investigated the dose-response relationships between weight status and clinical outcomes among infants hospitalized with respiratory syncytial virus infections.

METHODS

We obtained hospital discharge records for inpatients aged <12 months with diagnoses of bronchitis/pneumonia and respiratory syncytial virus infections, using a Japanese national inpatient database. The patients were classified into underweight, normal-weight, or overweight/obese groups using weight-for-length according to World Health Organization criteria. We compared need for intensive care, 30-day readmission, mean total hospitalization costs, and length of hospital stay across the three groups using multivariable mixed-effects regression models and restricted cubic spline functions.

RESULTS

Overall, 42 698 patients were identified, comprising 3697 underweight, 35 849 normal-weight, 3152 overweight/obese patients. The underweight group had significantly higher risk of intensive care (adjusted odds ratio, 1.35; 95% confidence interval, 1.18-1.82) and longer length of stay (adjusted difference, 0.12 days; 95% confidence interval, 0.04-0.20 days) than the normal-weight group. No significant differences in 30-day readmission or hospitalization costs were observed among the three groups. The lower and upper thresholds for a significant association between weight status and intensive care were weight-for-length z-scores of -0.64 (26th percentile) and 2.08 (98th percentile), respectively.

CONCLUSIONS

These findings demonstrate that abnormal weight status is an independent risk factor for greater illness severity among infants hospitalized with respiratory syncytial virus infections.