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Markham JL, Burns A, Hall M, Molloy MJ, Stephens JR, McCoy E, Ugalde IT, Steiner MJ, Cotter JM, House SA, Collins ME, Yu AG, Tchou MJ, Shah SS. Outcomes associated with initial narrow-spectrum versus broad-spectrum antibiotics in children hospitalized with urinary tract infections. J Hosp Med 2024. [PMID: 38734985 DOI: 10.1002/jhm.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE The aim of this study is to describe the proportion of children hospitalized with urinary tract infections (UTIs) who receive initial narrow- versus broad-spectrum antibiotics across children's hospitals and explore whether the use of initial narrow-spectrum antibiotics is associated with different outcomes. DESIGN, SETTING AND PARTICIPANTS We performed a retrospective cohort analysis of children aged 2 months to 17 years hospitalized with UTI (inclusive of pyelonephritis) using the Pediatric Health Information System (PHIS) database. MAIN OUTCOME AND MEASURES We analyzed the proportions of children initially receiving narrow- versus broad-spectrum antibiotics; additionally, we compiled antibiogram data for common uropathogenic organisms from participating hospitals to compare with the observed antibiotic susceptibility patterns. We examined the association of antibiotic type with adjusted outcomes including length of stay (LOS), costs, and 7- and 30-day emergency department (ED) revisits and hospital readmissions. RESULTS We identified 10,740 hospitalizations for UTI across 39 hospitals. Approximately 5% of encounters demonstrated initial narrow-spectrum antibiotics, with hospital-level narrow-spectrum use ranging from <1% to 25%. Approximately 80% of hospital antibiograms demonstrated >80% Escherichia coli susceptibility to cefazolin. In adjusted models, those who received initial narrow-spectrum antibiotics had shorter LOS (narrow-spectrum: 33.1 (95% confidence interval [CI]: 30.8-35.4) h versus broad-spectrum: 46.1 (95% CI: 44.1-48.2) h) and reduced costs [narrow-spectrum: $4570 ($3751-5568) versus broad-spectrum: $5699 ($5005-$6491)]. There were no differences in ED revisits or hospital readmissions. In summary, children's hospitals have low rates of narrow-spectrum antibiotic use for UTIs despite many reporting high rates of cefazolin-susceptible E. coli. These findings, coupled with the observed decreased LOS and costs among those receiving narrow-spectrum antibiotics, highlight potential antibiotic stewardship opportunities.
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Affiliation(s)
- Jessica L Markham
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Alaina Burns
- Department of Pharmacy, Children's Mercy Kansas City, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, USA
| | - Matthew Hall
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Matthew J Molloy
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - John R Stephens
- Departments of Medicine and Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Elisha McCoy
- Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Irma T Ugalde
- Department of Emergency Medicine, McGovern Medical School, Houston, Texas, USA
| | - Michael J Steiner
- Departments of Medicine and Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jillian M Cotter
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Samantha A House
- Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire, USA
| | - Megan E Collins
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Andrew G Yu
- Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA
| | - Michael J Tchou
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Albarrak M, Al Dabbagh M, Al Hashami H, Alzomor O, Ghatasheh G, Habashy N, Hassanien A, Pérez-López A. Urinary tract infections in children from the Gulf Cooperation Council countries: a literature review (2011-2022). Front Pediatr 2023; 11:1163103. [PMID: 37528872 PMCID: PMC10387756 DOI: 10.3389/fped.2023.1163103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Urinary tract infections (UTIs) are common healthcare-associated and community-acquired bacterial infections in children. Data on pediatric UTIs in the Gulf Cooperation Council (GCC) region (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) have not been collated. Our aim is to review the published literature on the risk factors, etiology, antimicrobial susceptibility, and treatment of pediatric (aged <18 years) UTIs from healthcare and community settings in the GCC countries.
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Affiliation(s)
- May Albarrak
- Pediatric Infectious Diseases Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mona Al Dabbagh
- Department of Pediatrics, Division of Infectious Diseases, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hilal Al Hashami
- Pediatric Infectious Diseases Department, Lean Healthcare Certification, Royal Hospital, Muscat, Oman
| | - Omar Alzomor
- Pediatric Infectious Diseases Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ghassan Ghatasheh
- Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates
| | | | | | - Andrés Pérez-López
- Division of Microbiology, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine in Qatar, Doha, Qatar
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Bradley JS. Urinary Tract Infections Treated by Third-Generation Cephalosporins. Pediatrics 2022; 150:188321. [PMID: 35734947 DOI: 10.1542/peds.2022-056219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- John S Bradley
- Rady Children's Hospital San Diego, Division of Infectious Diseases, San Diego, California.,Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California
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