Bacteraemic urinary tract infection: management and outcomes in young infants.

OBJECTIVES: To determine predictors of parenteral antibiotic duration and the association between parenteral treatment duration and relapses in infants <3 months with bacteraemic urinary tract infection (UTI). DESIGN: Multicentre retrospective cohort study. SETTING: Eleven healthcare institutions across the USA. PATIENTS: Infants <3 months of age with bacteraemic UTI, defined as the same pathogenic organism isolated from blood and urine. MAIN OUTCOME MEASURES: Duration of parenteral antibiotic therapy, relapsed UTI within 30 days. RESULTS: The mean (±SD) duration of parenteral antibiotics for the 251 included infants was 7.8 days (±4 days), with considerable variability between institutions (mean range 5.5-12 days). Independent predictors of the duration of parenteral antibiotic therapy included (coefficient, 95% CI): age (-0.2 days, -0.3 days to -0.08 days, for each week older), year treated (-0.2 days, -0.4 to -0.03 days for each subsequent calendar year), male gender (0.9 days, 0.01 to 1.8 days), a positive repeat blood culture during acute treatment (3.5 days, 1.2-5.9 days) and a non-Escherichia coli organism (2.2 days, 0.8-3.6 days). No infants had a relapsed bacteraemic UTI. Six infants (2.4%) had a relapsed UTI (without bacteraemia). The duration of parenteral antibiotics did not differ between infants with and without a relapse (8.2 vs 7.8 days, p=0.81). CONCLUSIONS: Parenteral antibiotic treatment duration in young infants with bacteraemic UTI was variable and only minimally explained by measurable patient factors. Relapses were rare and were not associated with treatment duration. Shorter parenteral courses may be appropriate in some infants.

Time to detection of bacterial cultures in infants aged 0 to 90 days.

OBJECTIVE: To determine the time to detection (TTD) of positive results on blood, urine, and cerebrospinal fluid (CSF) cultures taken during the evaluation for serious bacterial infection (SBI) in otherwise healthy infants aged 0 to 90 days. METHODS: This study was a retrospective chart review of infants aged 0 to 90 days with positive blood, urine, or CSF cultures drawn during evaluation for SBI in the emergency department or inpatient setting. The TTD of positive culture results, reason for testing, and age of the infant were recorded. RESULTS: A total of 283 charts were reviewed related to 307 positive culture results. Of the 101 positive results on blood culture, 38% were true pathogens with a mean TTD of 13.3 hours; 97% were identified in < or = 36 hours. Blood cultures with TTD > or = 36 hours were 7.8 times more likely to be contaminants compared with those with TTD < 36 hours. Of 192 positive results on urine culture, 58% were true pathogens with a mean TTD of 21 hours; 95% were identified in < or = 36 hours. Fifty percent of 14 positive CSF culture results were true pathogens with a mean TTD of 28.9 hours; 86% were identified in < or = 36 hours. When data for infants < or = 28 days of age were analyzed separately, TTD followed the same patterns for positive blood and urine culture results as seen in all infants aged 0 to 90 days. CONCLUSIONS: In certain clinical situations, the inpatient observation period for infants under evaluation for SBI may be decreased to 36 hours.