SAFE TRANSITION TO ORAL ANTIBIOTIC THERAPY FOR PYELONEPHRITIS IN CHILDREN UNDER 2 MONTHS OF AGE: A RETROSPECTIVE STUDY
Abstract BACKGROUND Febrile urinary tract infection (UTI) is a common cause of acute illness in paediatric medicine. Whereas oral antibiotic therapy (OAT) has become common practice in older children, the evidence supporting OAT in infants less than 2 months of age is still limited. The need for future research in the management strategies of UTIs in infants < 2 months of age has been acknowledged by the Canadian Paediatric Society. OBJECTIVES Describe the use of antibiotics in children < 2 months of age with a diagnosis of pyelonephritis at a Canadian tertiary care paediatric hospital and assess the safety of an early OAT switch in this population. DESIGN/METHODS A retrospective observational cohort study of infants < 2 months of age with a diagnosis of pyelonephritis based on 1) fever or systemic symptoms (lethargy, vomiting) and 2) a positive urine culture obtained from urinary catheterization. All children were seen between January 1st 2015 and July 30th 2017 at a single tertiary care centre. Infants were either hospitalized or followed in an outpatient day clinic. Chart review was performed and multiple variables were included in the analysis. RESULTS 105 patients were included. Among those, 81 (77%) were boys. Most patients (87%) had Escherichia coli infection. Patients presented at a mean age of 33 ± 15 days and were admitted for 3.7 ± 2.7 days. Intravenous antibiotic therapy (IAT) – ampicillin and tobramycin or ampicillin and cefotaxime – were initially used in most patients (96%) with transition to OAT after a mean IAT duration of 3.9 days ± 2.4 days. A renal ultrasound was performed in all patients. In a subgroup of patients aged less than 30 days without bacteremia (44 patients), mean age at presentation was 19 ± 6 days. They were treated with IAT for 3.7 days ± 1.9 days before transition to OAT based on urine culture and resolution of fever. No patient was readmitted for a renal complication following discharge. CONCLUSION Early use of OAT following an initial IAT in infants < 2 months of age with a diagnosis of pyelonephritis appears to be a safe option. In infants < 30 days of age without bacteremia, our data suggests that early transition to OAT is not associated with worse outcomes.