Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 16-22 (doi:10.1542/peds.2008-2583)
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ARTICLE

Urinary Tract Infections in 1- to 3-Month-Old Infants: Ambulatory Treatment With Intravenous Antibiotics

Marie-Joëlle Doré-Bergeron, MD, Marie Gauthier, MD, Isabelle Chevalier, MD, MSc, Barbara McManus, MD, Bruce Tapiero, MD and Sylvie Lebrun, RN

Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada

OBJECTIVE: The goal was to examine the feasibility of outpatient management for 1- to 3-month-old infants with febrile urinary tract infections.

METHODS: A cohort study was performed with all children 30 to 90 days of age who were evaluated for presumed febrile urinary tract infections in the emergency department of a tertiary-care pediatric hospital between January 1, 2005, and September 30, 2007. Patients were treated with intravenously administered antibiotics as outpatients in a day treatment center unless they met exclusion criteria, in which case they were hospitalized.

RESULTS: Of 118 infants included in the study, 67 (56.8%) were admitted to the day treatment center and 51 (43.2%) were hospitalized. The median age of day treatment center patients was 66 days (range: 33–85 days). The diagnosis of urinary tract infection was confirmed for 86.6% of patients treated in the day treatment center. Escherichia coli was identified in 84.5% of urine cultures; 98.3% of isolates were sensitive to gentamicin. Six blood cultures (10.3%) yielded positive results, 5 of them for E coli. Treatment with intravenously administered antibiotics in the day treatment center lasted a mean of 2.7 days. The mean number of visits, including appointments for voiding cystourethrography, was 2.9 visits. The rate of parental compliance with day treatment center visits was 98.3%. Intravenous access problems were seen in 8.6% of cases. Successful treatment in the day treatment center (defined as attendance at all visits, normalization of temperature within 48 hours, negative control urine and blood culture results, if cultures were performed, and absence of hospitalization from the day treatment center) was obtained for 86.2% of patients with confirmed urinary tract infections.

CONCLUSIONS: Ambulatory treatment of infants 30 to 90 days of age with febrile urinary tract infections by using short-term, intravenous antibiotic therapy at a day treatment center is feasible.

Key Words: urinary tract infection • pyelonephritis • child • ambulatory treatment

Abbreviations: UTI—urinary tract infection • ED—emergency department • DTC—day treatment center • CSF—cerebrospinal fluid • OR—odds ratio • CI—confidence interval

Accepted Nov 19, 2008.


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