Treatment of UTIs in Infants <2 Months: A Living Systematic Review

Abstract

CONTEXT Urinary tract infections (UTIs) are the most common bacterial infections in infants &lt;2 months of age. However, there are no clear guidelines on the appropriate duration of antibiotics in this age group. OBJECTIVE In this living systematic review, we compared different durations of parenteral antibiotics (≤3 vs &gt;3 days) in neonates and young infants (&lt;2 months) with UTIs. The secondary objective was to compare different durations of total antibiotic courses (≤10 vs &gt;10 days). DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Google Scholar, and gray literature, up to March 2, 2021. STUDY SELECTION Citations were screened in triplicate by using a crowdsourcing methodology, to identify randomized controlled trials and observational studies. DATA EXTRACTION Data were extracted by 2 crowd members and verified by an expert investigator. Outcomes were pooled via random-effects models. RESULTS A total of 10 334 citations were screened, and 12 eligible studies were identified. A total of 59 of 3480 (1.7% [95% confidence interval (CI): 1.3% to 2.2%]) infants had a UTI recurrence within 30 days after short parenteral treatment (≤3 days), and 47 of 1971 (2.4% [95% CI: 1.8% to 3.2%]) after longer courses. The pooled adjusted odds ratio for UTI recurrence with a short versus long duration of parenteral antibiotics was 1.02 (95% CI: 0.64 to 1.61; P = .95; n = 5451). A total of 5 studies assessed the risk of recurrence on the basis of the total duration of antibiotics (≤10 vs &gt;10 days) with no significant differences (pooled odds ratio: 1.29 [95% CI: 0.45 to 3.66; P = .63; n = 491). CONCLUSIONS On the basis of retrospective studies and Grading of Recommendations, Assessment, Development, and Evaluation level low evidence, short and long duration of parenteral antibiotics were associated with a similar risk of UTI recurrence in infants &lt;2 months.