SAFE TRANSITION TO ORAL ANTIBIOTIC THERAPY FOR PYELONEPHRITIS IN CHILDREN UNDER 2 MONTHS OF AGE: A RETROSPECTIVE STUDY
Bibliographic record
Abstract
Abstract BACKGROUND Febrile urinary tract infection (UTI) is a common cause of acute illness in paediatric medicine. Whereas oral antibiotic therapy (OAT) has become common practice in older children, the evidence supporting OAT in infants less than 2 months of age is still limited. The need for future research in the management strategies of UTIs in infants < 2 months of age has been acknowledged by the Canadian Paediatric Society. OBJECTIVES Describe the use of antibiotics in children < 2 months of age with a diagnosis of pyelonephritis at a Canadian tertiary care paediatric hospital and assess the safety of an early OAT switch in this population. DESIGN/METHODS A retrospective observational cohort study of infants < 2 months of age with a diagnosis of pyelonephritis based on 1) fever or systemic symptoms (lethargy, vomiting) and 2) a positive urine culture obtained from urinary catheterization. All children were seen between January 1st 2015 and July 30th 2017 at a single tertiary care centre. Infants were either hospitalized or followed in an outpatient day clinic. Chart review was performed and multiple variables were included in the analysis. RESULTS 105 patients were included. Among those, 81 (77%) were boys. Most patients (87%) had Escherichia coli infection. Patients presented at a mean age of 33 ± 15 days and were admitted for 3.7 ± 2.7 days. Intravenous antibiotic therapy (IAT) – ampicillin and tobramycin or ampicillin and cefotaxime – were initially used in most patients (96%) with transition to OAT after a mean IAT duration of 3.9 days ± 2.4 days. A renal ultrasound was performed in all patients. In a subgroup of patients aged less than 30 days without bacteremia (44 patients), mean age at presentation was 19 ± 6 days. They were treated with IAT for 3.7 days ± 1.9 days before transition to OAT based on urine culture and resolution of fever. No patient was readmitted for a renal complication following discharge. CONCLUSION Early use of OAT following an initial IAT in infants < 2 months of age with a diagnosis of pyelonephritis appears to be a safe option. In infants < 30 days of age without bacteremia, our data suggests that early transition to OAT is not associated with worse outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".