Frequency of treatment failure of UTIs in children with congenital urinary tract anomalies

Authors: FORSTER, CATHERINE - University Of Pittsburgh; WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); DAVIS-RODRIGUEZ, STEPHANIE - University Of Cincinnati College Of Medicine; CHANG, PEARL - Seattle Children’s Hospital; DESAI, SANYUKTA - Dell Children'S Medical Center; TCHOU, MICHAEL - Children’s Hospital Colorado; MORRISON, JOHN - Johns Hopkins University School Of Medicine; MUDD, JAMIE - University Of Cincinnati College Of Medicine; CASEY, BRITTANY - Johns Hopkins University School Of Medicine; TREVISANUT, VICTOR - Dell Children'S Medical Center; HAMDY, RANA - Children'S National Medical Center; VEMULAKONDA, VIJAYA - Children’s Hospital Colorado; BRADY, PATRICK - University Of Cincinnati College Of Medicine; WALLACE, SOWDHAMNI - Texas Children'S Hospital

Submitted to: Hospital Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/15/2024
Publication Date: 3/1/2024
Citation: Forster, C.S., Wood, A.C., Davis-Rodriguez, S., Chang, P.W., Desai, S., Tchou, M., Morrison, J.M., Mudd, J.D., Casey, B.D., Trevisanut, V., Hamdy, R.F., Vemulakonda, V., Brady, P.W., Wallace, S.S. 2024. Frequency of treatment failure of UTIs in children with congenital urinary tract anomalies. Hospital Pediatrics. 14(3):189-196. https://doi.org/10.1542/hpeds.2023-007427.
DOI: https://doi.org/10.1542/hpeds.2023-007427

Interpretive Summary: Children with obesity, are at a higher risk of treatment failure for urinary tract infections (UTIs), whereby initial treatment with standard antibiotic protocols does not fully eradicate the infection. Some doctors now recommend longer courses of antibiotic therapy for children with obesity, versus those without, but it is not clear whether antibiotic treatment length improves success rates. The goal of this study was to use a retrospective chart review of data from Texas Children's Hospital, one of the nation's largest, multicenter hospitals, to determine whether children with treatment failure had shorter durations of antibiotics treatment than those whose UTI treatment was a success. In this study, we defined UTI treatment failure as a subsequent emergency department visit, or hospitalization, for UTI because of the same pathogen within 30 days of finishing prior treatment. In our analysis, there was no difference in the mean duration of intravenous antibiotics (3.4 vs 3.5 days for treatment failure vs. success) or total (intravenous and oral) antibiotics (10.2 vs 10.8 days for treatment failure vs. success) for children who experienced treatment failure vs. treatment success. These analyses do not support the notion that longer antibiotic use will improve treatment outcomes for UTIs in children with obesity.

Technical Abstract: Children with certain congenital anomalies of the kidney and urinary tract and neurogenic bladder (CAKUT/NGB) are at higher risk of treatment failure for urinary tract infections (UTIs) than children with normal genitourinary anatomy, but the literature describing treatment and outcomes is limited. The objectives of this study were to describe the rate of treatment failure in children with CAKUT/NGB and compare duration of antibiotics between those with and without treatment failure. Multicenter retrospective cohort of children 0 to 17 years old with CAKUT/NGB who presented to the emergency department with fever or hypothermia and were diagnosed with UTI between 2017 and 2018. The outcome of interest was treatment failure, defined as subsequent emergency department visit or hospitalization for UTI because of the same pathogen within 30 days of the index encounter. Descriptive statistics and univariates analyses were used to compare covariates between groups. Of the 2014 patient encounters identified, 482 were included. Twenty-nine (6.0%) of the 482 included encounters had treatment failure. There was no difference in the mean duration of intravenous antibiotics (3.4+/-2.5 days, 3.5+/-2.8 days, P=.87) or total antibiotics between children with and without treatment failure (10.2+/-3.8 days, 10.8+/-4.0 days, P=.39) Of note, there was a higher rate of bacteremia in children with treatment failure (P=.04). In children with CAKUT/NGB and UTI, 6.0% of encounters had treatment failure. Duration of antibiotics was not associated with treatment failure. Larger studies are needed to assess whether bacteremia modifies the risk of treatment failure.