Efficacy of short-term intravenous antibiotic in neonates with urinary tract infection.
BACKGROUND
Recent studies have questioned the use of prolonged intravenous treatment in neonates with urinary tract infection (UTI). The aim of the present study was to examine the clinical course of neonates with UTI with special attention paid to the rates of bacteremia and meningitis and to determine the efficacy of short-term intravenous antibiotic.


METHODS
Retrospective review of clinical charts of neonates admitted for UTI. Patients were treated first intravenously with a beta-lactam antibiotic and gentamicin. Treatment was completed orally.


RESULTS
One hundred seventy-two neonates (median age, 19 days) were included. Of 129 blood cultures carried out, 16 (12.4%) were positive. Analysis of cerebrospinal fluid was performed in 75 patients; none of the cultures was positive. Forty-nine patients (28.5%) were treated with ampicillin and gentamicin and 105 (61%) with amoxicillin-clavulanate and gentamicin. The median length of intravenous treatment was 4 days (P25: 3; P75: 6). Oral amoxicillin-clavulanate was used in the continuation phase in 75%. No treatment failure or relapse was detected. Eleven (8.7%) of 126 patients had renal scarring at 6 months.


CONCLUSIONS
The clinical course in neonates with UTI treated with short-term intravenous antibiotic followed by oral treatment is highly favorable, both in short and long terms. The absence of meningitis and the good evolution of the associated bacteremias argue in favor of a review of the habitual diagnostic-therapeutic protocol in neonates.
Magín
Ester Corrales
EC
Emergency Department, Unitat Integrada Sant Joan de Déu-Clínic, Universitat de Barcelona, Barcelona, Spain.
García-García
Juan-José
JJ
Sert
Sílvia Zambudio
SZ
Giralt
Amadeu Gené
AG
Cubells
Carles Luaces
CL
D000208:Acute Disease; D000284:Administration, Oral; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy*; D047090:beta-Lactams / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D047090:beta-Lactams; D019980:Amoxicillin-Potassium Clavulanate Combination