Outpatient Treatment of Uncomplicated Urinary Tract Infections in the Emergency Department

In this prospective study of 442 infants younger than 8 weeks of age who attended a pediatric emergency department with temperature ≥100.6°F (38.1° C), urinary tract infections (UTIs) were found in 33 patients (7.5%), 2 of whom were bacteremic. Clinical and laboratory data were not helpful for identifying UTIs. Of the 33 patients with UTIs, 32 had urinalyses recorded; 16 were suggestive of a UTI (more than five white blood cells per high-power field or any bacteria present). Of the 16 infants with apparently normal urinalysis results, three had an emergency department diagnosis suggesting an alternative bacterial focus of infection. If the physician had decided on the basis of apparently normal urinalysis results to forgo obtaining a urine culture, more than half of the UTIs would have been missed. Bag-collected specimens were significantly more likely to yield indeterminate urine culture results than either catheter or suprapublic specimens. In addition, uncircumcised males were significantly more likely to have a UTI than circumcised boys. These results suggest that a suprapubic or catheter-obtained urine specimen for culture is a necessary part of the evaluation of all febrile infants younger than 8 weeks of age, regardless of the urinalysis findings or another focus of presumed bacterial infection.

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Fosfomycin versus Ertapenem for Outpatient Treatment of Complicated Urinary Tract Infections: A Multicenter, Retrospective Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab620 ◽

2021 ◽

Author(s):

Noah Wald-Dickler ◽

Todd C Lee ◽

Soodtida Tangpraphaphorn ◽

Susan M Butler-Wu ◽

Nina Wang ◽

...

Keyword(s):

Cohort Study ◽

Urinary Tract ◽

Los Angeles ◽

Urinary Tract Infections ◽

Retrospective Cohort Study ◽

Outpatient Treatment ◽

Retrospective Cohort ◽

Clinical Success ◽

Public Hospitals ◽

Tract Infections

Abstract Objectives We sought to determine the comparative efficacy of fosfomycin vs. ertapenem for outpatient treatment of complicated urinary tract infections (cUTI). Methods We conducted a multi-centered, retrospective cohort study involving patients with cUTI treated with outpatient oral fosfomycin vs. intravenous ertapenem at three public hospitals in Los Angeles County between January 2018 and September 2020. The primary outcome was resolution of clinical symptoms 30 days after diagnosis. Results We identified 322 patients with cUTI treated with fosfomycin (n = 110) or ertapenem (n = 212) meeting study criteria. Study arms had similar demographics, although patients treated with ertapenem more frequently had pyelonephritis or bacteremia while fosfomycin-treated patients had more retained catheters, nephrolithiasis, or urinary obstruction. Most infections were due to extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae; 80-90% of which were resistant to other oral options. Adjusted odds ratios for clinical success at 30 days, clinical success at last follow up, and relapse were 1.21 (0.68 to 2.16), 0.84 (0.46 to 1.52), and 0.94 (0.52 to 1.70), for fosfomycin vs. ertapenem, respectively. Patients treated with fosfomycin had significant reductions in length of hospital stay and length of antimicrobial therapy, and fewer adverse events (1 vs. 10). Fosfomycin outcomes were similar irrespective of duration of lead-in IV therapy or fosfomycin dosing interval (daily, every other day, every third day). Conclusion These results would support the conduct of a randomized controlled trial to verify efficacy. In the meantime, they suggest fosfomycin may be a reasonable stepdown from IV antibiotics for cUTI.

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