Clinical Outcome of Discordant Empirical Therapy and Risk Factors Associated to Treatment Failure in Children Hospitalized for Urinary Tract Infections
Giovanni Autore,
Cosimo Neglia,
Margherita Di Costanzo,
Martina Ceccoli,
Gianluca Vergine,
Claudio La Scola,
Cristina Malaventura,
Alice Falcioni,
Alessandra Iacono,
Antonella Crisafi,
Lorenzo Iughetti,
Maria Luisa Conte,
Luca Pierantoni,
Claudia Gatti,
Giacomo Biasucci,
Susanna Esposito,
UTI-Ped-ER Study Group
Affiliations
Giovanni Autore
Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
Cosimo Neglia
Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
Margherita Di Costanzo
Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy
Martina Ceccoli
Paediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
Gianluca Vergine
Paediatrics Unit, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy
Claudio La Scola
Paediatric Clinic, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
Cristina Malaventura
Paediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
Alice Falcioni
Paediatric Unit, Forlì Hospital, AUSL Romagna, 47121 Forlì, Italy
Alessandra Iacono
Paediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, 48121 Ravenna, Italy
Antonella Crisafi
Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
Lorenzo Iughetti
Paediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
Maria Luisa Conte
Paediatrics Unit, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy
Luca Pierantoni
Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
Claudia Gatti
Paediatric Surgery, University Hospital, 43126 Parma, Italy
Giacomo Biasucci
Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy
Susanna Esposito
Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
With the spread of antibiotic resistance in pediatric urinary tract infections (UTIs), more patients are likely to be started empirically on antibiotics to which pathogens are later found to be resistant (discordant therapy). However, in-vivo effectiveness may be different from in-vitro susceptibility. Aims of this study were to describe clinical outcomes of discordant empirical treatments in pediatric UTIs and to investigate risk factors associated to treatment failure. This observational, retrospective study was conducted on children hospitalized for febrile UTIs with positive urine culture and started on discordant empirical therapy. Failure rates of discordant treatments and associated risk factors were investigated. A total of 142/1600 (8.9%) patients were treated with inadequate empirical antibiotics. Clinical failure was observed in 67/142 (47.2%) patients, with no fatal events. Higher failure rates were observed for combinations of penicillin and beta-lactamase inhibitors (57.1%). Significant risk factors for failure of discordant treatment were history of recurrent UTIs (95% CI: 1.13–9.98, OR: 3.23, p p Pseudomonas aeruginosa (95% CI: 1.85–62.10, OR: 7.30, p p = 0.05). This study showed that discordant empirical treatments may still be effective in more than half of pediatric UTIs. Clinical effectiveness varies between different discordant antibiotics in pediatric UTIs, and patients presenting risk factors for treatment failure may need a differentiated empirical approach.
