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Outpatient and oral management is suitable for infants 60–90 days old with urinary tract infections at low risk of bacteremia

Abstract

One previous study recommended oral and outpatient management for those infants aged 60–90 days with urinary tract infection (UTI) meeting the low-risk criteria identified: to be well-appearing and to have a procalcitonin value of < 0.7 ng/mL. A retrospective study was conducted, including infants aged 29 to 90 days with UTI from 2014 to 2019, to validate these low-risk criteria identified and determine the adherence to the new algorithm for managing these patients at the Emergency Department. Two hundred one patients were included; 105 (52.2%) were aged 60 to 90 days. Twelve (6%, 95% CI 3.4–10.1%) had bacteremia. One hundred thirty-six (67.7%) infants met low-risk criteria; none had a positive blood culture (0%, 95% CI 0–2.7%). Overall protocol adherence was 90.6%. One hundred and forty-four (71.6%) infants were admitted to the hospital; all patients meeting high-risk criteria were hospitalized. Among the 57 (28.4%) infants initially sent home, 4 (7.0%) required later hospital admission.

Conclusions: A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia. Outpatient management with appropriate follow-up is safe for these infants.

What is Known:
• Patients under 2–3 months of age with a presumptive urinary tract infection (UTI) are commonly hospitalized because of concerns regarding concomitant bacteremia.
What is New:
• A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia. Outpatient management with appropriate follow-up is safe for these infants.

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Fig. 1

Availability of data and material

Raw data are available upon reasonable request (correspondence author).

Abbreviations

BC:

Blood culture

CSF:

Cerebrospinal fluid

CI:

Confidence interval

ED:

Emergency Department

GBS:

Group B Streptococcus

ICU:

Intensive care unit

IQR:

Interquartile range

NPV:

Negative predictive value

PAT:

Pediatric Assessment Triangle

PCT:

Procalcitonin

SBI:

Serious bacterial infection

UC:

Urine culture

UTI:

Urinary tract infection

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Affiliations

Authors

Contributions

SHB: conceptualized and designed the study, enrolled patients, analyzed and interpreted data, drafted the initial manuscript, and revised and approved the final manuscript as submitted. VT: conceptualized and designed the study, was involved in obtaining ethics approval, enrolled patients, analyzed and interpreted data, revised the manuscript, and approved the final manuscript as submitted. ASG, MC, and MC: did data collection and approved the final manuscript as submitted. CL: provided critical review of the original and subsequent manuscript drafts, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Victoria Trenchs.

Ethics declarations

Ethics approval

The study was approved by the hospital’s Ethics Committee (PIC-65–19). Since the data were extracted from a registry, the information contained in it was anonymous, and since no interventions were performed on patients, informed consent was not required or requested.

Conflicts of interest

The authors declare no competing interests.

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Communicated by Nicole Ritz

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Cite this article

Hernández-Bou, S., Trenchs, V., Soler-Garcia, A. et al. Outpatient and oral management is suitable for infants 60–90 days old with urinary tract infections at low risk of bacteremia. Eur J Pediatr (2021). https://doi.org/10.1007/s00431-021-04224-7

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Keywords

  • Bacteremia
  • Prediction model
  • Procalcitonin
  • Urinary tract infection
  • Young infant