title: Incidence of Breakthrough Urinary Tract Infection in Hospitalized Infants Receiving Antibiotic Prophylaxis.
abstract: Urinary tract infections (UTIs) are a source of substantial morbidity in children in the neonatal intensive care unit. The incidence of UTIs that occur in critically ill infants during a course of antibiotic prophylaxis (i.e., breakthrough urinary tract infections [BUTIs]) is not known. We investigated the incidence of BUTI in a cohort of infants hospitalized on prophylactic antibiotics in neonatal intensive care units. Predictors of BUTI were evaluated using multivariable Cox regression. Out of 716 787 infants, 631 (0.09%) were prescribed 821 courses of antibiotic prophylaxis. Among this cohort, 60 infants (9.5%) suffered a total of 65 BUTIs. Of all prophylactic antibiotic courses, 65/821 (7.9%) were complicated by BUTI. Klebsiella, Enterobacter, and Escherichia coli species were the most common causes of BUTI. There was no statistically significant difference ( P = .78) in BUTI incidence among the 4 antibiotics assessed (amoxicillin, cephalexin, nitrofurantoin, or trimethoprim-sulfamethoxazole).
authors.affiliation: 1 Duke University School of Medicine, Durham, NC, USA.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Lloyd
authors.affiliation: 1 Duke University School of Medicine, Durham, NC, USA.
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
authors.affiliation: 2 Clemson University, Clemson, SC, USA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.affiliation: 3 Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, USA.
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.affiliation: 1 Duke University School of Medicine, Durham, NC, USA.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
authors.affiliation: 1 Duke University School of Medicine, Durham, NC, USA.
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
keywords: antibiotics; antimicrobial prophylaxis; breakthrough urinary tract infection; infants; neonatal intensive care units