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Efficacy of Short-Term Intravenous Antibiotic in Neonates With Urinary Tract Infection

Magín, Ester Corrales MD*; García-García, Juan-José PhD*; Sert, Sílvia Zambudio MD*; Giralt, Amadeu Gené MD; Cubells, Carles Luaces PhD*

doi: 10.1097/PEC.0b013e3180302c47
Original Articles

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 β-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.

*Emergency Department and Pediatric Department, Unitat Integrada Sant Joan de Déu-Clínic and †Microbiology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.

Address correspondence and reprint requests to Juan-José Garcia Garcia, PhD, Pediatric Department, Hospital Sant Joan de Déu, P. Sant Joan de Déu n° 2, 08950 Esplugues de Llobregat, Barcelona, Spain. E-mail: juanjo@hsjdbcn.org.

© 2007 Lippincott Williams & Wilkins, Inc.