Methods: A retrospective cohort analysis of pediatric patients aged 2-17 years with first cystitis or pyelonephritis and without renal/anatomic abnormality was performed using claims and eligibility data from Truven Health MarketScan Database for 2013-2015. Parenteral ABX use and treatment of cystitis diagnosis only were covariates. Relapse and reinfection were defined a priori as UTI diagnosed from, respectively, 0-14 days and 15-30 days following ABX depletion; recurrence was defined as either relapse or reinfection. Progressing infection was defined as recurrence diagnosis of pyelonephritis in a patient originally diagnosed with cystitis only.
Results: Of 7,698 pediatric patients (43.8% aged 2-10 years; 56.2% aged 11-17 years), 85.5% had cystitis and 14.3% pyelonephritis. Duration of ABX treatment included: 3-5-days for cystitis only (20.4%), or 7 (33.6%), 10 (44.2%), or 14 (1.8%) days for any UTI. Recurrence and progressing infection occurred in 5.5% and 0.2% of patients, respectively. Covariates associated with increased recurrence risk included pre-treatment ABX exposure (OR=1.29; 95% CI=1.06-1.57); pyelonephritis on diagnosis date (OR=1.44; 95% CI=1.03-2.00); follow-up visit during ABX treatment (OR=3.21; 95% CI=2.20-4.68); parenteral ABX (OR=1.89, 95% CI=1.33-2.69); use of nitrofurantoin (NFT) only (OR=1.34, 95% CI=1.00-1.92); and interaction of NFT with pyelonephritis diagnosis (OR=3.68, 95% CI=1.20-11.29). After adjustment for measured confounders, the association between duration of ABX treatment and recurrence was not significant (compared with 7 days, 10 days: OR=1.07, 95% CI=0.85-1.33; compared with 7 days, 14 days: OR=0.89, 95%=CI 0.45-1.78).
Conclusion: In a national cohort of pediatric patients with uncomplicated UTI, rates of recurrence after ABX depletion did not significantly differ among treatment durations of 7, 10, and 14 days. Results provide support for, without definitively establishing efficacy of, shorter-course ABX treatment.
T. M. Afolabi,
K. A. Fairman, None