ESPN 50th Annual Meeting

ESPN 2017


 
Cefotaxime versus Piperacillin-tazobactam as empirical treatment for febrile urinary tract infection in infants less than 3 months old
JAE HONG CHOI 1 MIN-SU OH 1 SORINA KIM 1 JUYEON LEE 1 YOON-JOO KIM 2 HYUN SIK KANG 2 SEUNG HYO KIM 2 SANGHOON HAN 3 KI-SOO KANG 2 KYOUNG HEE HAN 2

1- DEPARTMENT OF PEDIATRICS, JEJU NATIONAL UNIVERSITY HOSPITAL, JEJU, KOREA
2- DEPARTMENT OF PEDIATRICS, JEJU NATIONAL UNIVERSITY SCHOOL OF MEDICINE, JEJU, KOREA
3- DEPARTMENT OF INTERNAL MEDICINE, JEJU NATIONAL UNIVERSITY SCHOOL OF MEDICINE, JEJU, KOREA
 
Introduction:

In 2011, American Academy of pediatrics reported clinical practice guideline for the management of the initial urinary tract infection (UIT) in febrile infants more than 2 months old. In 2001, EAU guidelines just suggested subsequent dosage adjustment of antibiotics to compensate for renal function deficit and some contraindicated drugs in young infants with UTI. There was a lack of clinical guideline for UTI under the age of 2 years.  This study was conducted to evaluate the efficacy and safety of piperacillin-tazobactam compared with cefotaxime as empirical antibiotics treatment for febrile UTI in infants less than 3 months old.

Material and methods:

Infants less than 3 months old who admitted for febrile UTI between Jan 2014 and Feb 2017 were enrolled, and their medical records were retrospectively reviewed. Clinical characteristics and outcomes were compared according to antimicrobial usage.

Results:

Eighty three infants (66 boys and 17 girls) were enrolled in this study. Eighteen patients (21.7%) experienced recurrent UTI during the follow-up period. Urine cultures were proven in 76 patients (91.6%), blood cultures were isolated in 9  (10.8%), and ESBL were positive in 13 (15.7%). Thirty five patients (42.2%) were treated with cefotaxime, 39 (47%) were treated with piperacillin-tazobactam, and 8 (9.6%) were treated with switching from a non-carbapenem to a carbapenem. There were no significant differences in clinical characteristics between cefotaxime and piperacillin-tazobactam treatment groups. Four patients among 35 (11.4%) in cefotaxime group and 12 among 39 (30.8%) in piperacillin-tazobactam group had recurrent UTI (P=0.052). Factors associated with recurrence of UTI in infants less than 3 months old were ESBL-producing bacteria in urine culture (P=0.026), bacteremia (P=0.009), and elevated blood urea nitrogen and creatinine (P=0.003, P=0.034, respectively).

Conclusions:

Piperacillin-tazobactam antibiotics showed no favorable outcomes in terms of recurrence of UTI as empirical treatment for UTIs in infants less than 3 months old comparing with cefotaxime. Close clinical follow-up monitoring should be maintained to detect early on whether patients with risk factors have recurrent UTI regardless of urinary tract anomalies.