Outcomes associated with initial narrow-spectrum versus broad-spectrum antibiotics in children hospitalized with urinary tract infections

Jessica L Markham; Alaina Burns; Matthew Hall; Matthew J Molloy; John R Stephens; Elisha McCoy; Irma T Ugalde; Michael J Steiner; Jillian M Cotter; Samantha A House; Megan E Collins; Andrew G Yu; Michael J Tchou; Samir S Shah

doi:10.1002/jhm.13390

Outcomes associated with initial narrow-spectrum versus broad-spectrum antibiotics in children hospitalized with urinary tract infections

J Hosp Med. 2024 May 12. doi: 10.1002/jhm.13390. Online ahead of print.

Authors

Jessica L Markham^{1

2}, Alaina Burns³, Matthew Hall^{1

4}, Matthew J Molloy^{5

6}, John R Stephens⁷, Elisha McCoy⁸, Irma T Ugalde⁹, Michael J Steiner⁷, Jillian M Cotter¹⁰, Samantha A House¹¹, Megan E Collins¹, Andrew G Yu¹², Michael J Tchou¹⁰, Samir S Shah^{5

6}

Affiliations

¹ Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
² Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas, USA.
³ Department of Pharmacy, Children's Mercy Kansas City, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, USA.
⁴ Children's Hospital Association, Lenexa, Kansas, USA.
⁵ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁶ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁷ Departments of Medicine and Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA.
⁸ Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁹ Department of Emergency Medicine, McGovern Medical School, Houston, Texas, USA.
¹⁰ Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
¹¹ Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire, USA.
¹² Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA.

PMID: 38734985
DOI: 10.1002/jhm.13390

Abstract

Objective: The aim of this study is to describe the proportion of children hospitalized with urinary tract infections (UTIs) who receive initial narrow- versus broad-spectrum antibiotics across children's hospitals and explore whether the use of initial narrow-spectrum antibiotics is associated with different outcomes.

Design, setting and participants: We performed a retrospective cohort analysis of children aged 2 months to 17 years hospitalized with UTI (inclusive of pyelonephritis) using the Pediatric Health Information System (PHIS) database.

Main outcome and measures: We analyzed the proportions of children initially receiving narrow- versus broad-spectrum antibiotics; additionally, we compiled antibiogram data for common uropathogenic organisms from participating hospitals to compare with the observed antibiotic susceptibility patterns. We examined the association of antibiotic type with adjusted outcomes including length of stay (LOS), costs, and 7- and 30-day emergency department (ED) revisits and hospital readmissions.

Results: We identified 10,740 hospitalizations for UTI across 39 hospitals. Approximately 5% of encounters demonstrated initial narrow-spectrum antibiotics, with hospital-level narrow-spectrum use ranging from <1% to 25%. Approximately 80% of hospital antibiograms demonstrated >80% Escherichia coli susceptibility to cefazolin. In adjusted models, those who received initial narrow-spectrum antibiotics had shorter LOS (narrow-spectrum: 33.1 (95% confidence interval [CI]: 30.8-35.4) h versus broad-spectrum: 46.1 (95% CI: 44.1-48.2) h) and reduced costs [narrow-spectrum: $4570 ($3751-5568) versus broad-spectrum: $5699 ($5005-$6491)]. There were no differences in ED revisits or hospital readmissions. In summary, children's hospitals have low rates of narrow-spectrum antibiotic use for UTIs despite many reporting high rates of cefazolin-susceptible E. coli. These findings, coupled with the observed decreased LOS and costs among those receiving narrow-spectrum antibiotics, highlight potential antibiotic stewardship opportunities.

Abstract

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