Predictors of long length of stay in infants hospitalized with urinary tract infection

Janet A McMullen; Sanjay Mahant; Julie M DeGroot; Derek Stephens; Patricia C Parkin

doi:10.1542/hpeds.2014-0020

Predictors of long length of stay in infants hospitalized with urinary tract infection

Hosp Pediatr. 2014 Sep;4(5):291-7. doi: 10.1542/hpeds.2014-0020.

Authors

Janet A McMullen¹, Sanjay Mahant², Julie M DeGroot³, Derek Stephens⁴, Patricia C Parkin⁵

Affiliations

¹ Undergraduate Medical Education Doctor of Medicine Program.
² Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada, and Child Health Evaluative Sciences, and Department of Paediatrics, Faculty of Medicine Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
³ Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada, and.
⁴ Clinical Research Sciences, SickKids Research Institute, Toronto, Ontario, Canada Dalla Lana School of Public Health, and.
⁵ Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada, and Child Health Evaluative Sciences, and Department of Paediatrics, Faculty of Medicine Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada patricia.parkin@sickkids.ca.

PMID: 25318111
DOI: 10.1542/hpeds.2014-0020

Abstract

Objective: Urinary tract infection (UTI) is the most common serious bacterial infection in infants. To use resources optimally, factors contributing to costs through length of stay (LOS) must be identified. This study sought to identify clinical and health system factors associated with long LOS in infants with UTI.

Methods: Using a case-control design, we included infants <6 months old hospitalized with UTI. Cases had LOS ≥96 hours; controls had LOS <96 hours. Clinical and health system variables were extracted from medical records. Cases and controls were compared by using comparative statistics and multiple logistic regression analysis.

Results: Cases (n = 71) and controls (n = 71) did not differ by gender; cases were more likely to be younger (4.2 vs 7.1 weeks, P = .04), born preterm (13% vs 3%, P = .03), have known genitourinary disease (17% vs 4%, P = .01), an ultrasound (85% vs 68%, P = .02) or voiding cystourethrogram (VCUG) (61% vs 34%, P = .001) ordered, longer wait for VCUG (53 vs 27 hours, P = .002), consult requested (54% vs 10%, P < .001), and longer duration of intravenous (IV) antibiotics (125 vs 62 hours, P < .001). Multiple logistic regression demonstrated that cases were more likely to be premature (odds ratio [OR] 7.6), have known genitourinary disease (OR 7.3), and have VCUG ordered in the hospital (OR 4.5).

Conclusions: Infants who are older, are born full term, have no genitourinary disease, receive shorter courses of IV antibiotics, and do not have a VCUG ordered have shorter stays and may be eligible for a short-stay unit. Earlier transition to oral antibiotics and delayed ordering of a VCUG may decrease LOS.

Keywords: diagnostic imaging; length of stay; pediatrics; urinary tract infections.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Case-Control Studies
Female
Humans
Infant
Infant, Newborn
Length of Stay / statistics & numerical data*
Logistic Models
Male
Urinary Tract Infections / therapy*