Is discordant antibiotic use appropriate for third-generation cephalosporin-resistant UTIs?

Most children treated with discordant antibiotics for third-generation cephalosporin-resistant urinary tract infections (UTIs) may experience initial clinical improvement, with only a few requiring escalation of care, according to a study. This highlights the aptness of using current narrow-spectrum empiric therapy regimens while awaiting final urine culture results.

The retrospective study included 316 children (median age, 2.4 years; 78 percent girls) with third-generation cephalosporin-resistant UTIs, defined as the growth of ≥50,000 colony-forming units per mL of Escherichia coli or Klebsiella spp. nonsusceptible to ceftriaxone with a positive urinalysis.

More than half of the population (56 percent) were evaluated in the emergency department and 43 percent in a clinic; 90 percent were initiated on a cephalosporin. Two hundred and thirty children (73 percent) showed clinical response, among whom 192 (83.5 percent) experienced clinical improvement. Seven children (2.2 percent) required escalation of care.

In the group of children with repeat urine testing while on discordant therapy, pyuria was improved or resolved in 16 of 19 (84 percent) and urine cultures were sterilized in 11 of 17 (65 percent).

The present data show that current empiric UTI regimens, as informed by local susceptibility patterns, are reasonable while awaiting urine culture results, researchers said. Additional investigation is warranted to gain some insight into the natural history of UTIs and/or trigger and into the relationship between in vitro urine culture susceptibilities and in vivo clinical response to treatment.