Fellows journal Club
Fellow: Nathan Money, DO, Pediatric Hospital Medicine Fellow, Baylor College of Medicine, Texas Children’s Hospital
Article: Fox MT, Amoah J, Hsu AJ, Herzke CA, Gerber JS, Tamma PD. Comparative Effectiveness of Antibiotic Treatment Duration in Children With Pyelonephritis. JAMA Netw Open. 2020;3(5):e203951. doi:10.1001/jamanetworkopen.2020.3951
Summary: Current recommendations for pediatric pyelonephritis are to treat with antibiotics for 7-14 days. Adult studies have shown noninferiority for shorter treatment durations, but studies in pediatrics are lacking. This multicenter, retrospective chart review compared rates of treatment failure in children with pyelonephritis who were treated with a short (<10 days) or prolonged (≥10 days) course of antibiotics. Inverse probability of treatment weighting was performed to account for between-group differences in baseline characteristics.
Of 791 children with pyelonephritis, 297 (37.5%) were prescribed a short antibiotic course. The odds of treatment failure did not differ between groups (short - 11.2% vs prolonged - 9.4%; OR, 1.22; 95% CI, 0.75-1.98). 37 total children experienced a UTI recurrence within 30 days. Of those, 6 of 15 (40%) in the short-course group and 14 of 22 (64%) in the prolonged-course group grew an organism with increased antibiotic resistance from prior (OR, 0.36; 95% CI, 0.09-1.43), though this did not meet statistical significance.
Key Strengths: The authors increased generalizability by including all patients with pyelonephritis, including frequently excluded populations such as patients who were critically ill, immunocompromised, or had preexisting urologic abnormalities. To help account for treatment bias, the authors used these characteristics to generate a cohort based on probability of treatment-weighted propensity scores. Finally, data integrity was strengthened by identifying patients using a clinical definition of pyelonephritis confirmed by manual chart review rather than relying on diagnosis codes.
Limitations: As a retrospective study, these results are subject to bias. Subjects were from a single hospital system and may not be generalizable. The authors only had access to follow-up data if subjects sought care within the same health system. Also, a rather broad definition of pyelonephritis may have captured subjects without pyelonephritis.
Main Takeaway: A cohort of pediatric patients with pyelonephritis who were treated with a shorter course of antibiotics (<10 days, median 8 days) had similar rates of treatment failure to those treated with longer courses (≥10 days, median 11 days).
Impact on Practice: Similar to adult literature, pediatric patients with pyelonephritis may be adequately treated with a shorter antibiotic course. This may help combat the emergence of drug-resistant organisms.
Article: Fox MT, Amoah J, Hsu AJ, Herzke CA, Gerber JS, Tamma PD. Comparative Effectiveness of Antibiotic Treatment Duration in Children With Pyelonephritis. JAMA Netw Open. 2020;3(5):e203951. doi:10.1001/jamanetworkopen.2020.3951
Summary: Current recommendations for pediatric pyelonephritis are to treat with antibiotics for 7-14 days. Adult studies have shown noninferiority for shorter treatment durations, but studies in pediatrics are lacking. This multicenter, retrospective chart review compared rates of treatment failure in children with pyelonephritis who were treated with a short (<10 days) or prolonged (≥10 days) course of antibiotics. Inverse probability of treatment weighting was performed to account for between-group differences in baseline characteristics.
Of 791 children with pyelonephritis, 297 (37.5%) were prescribed a short antibiotic course. The odds of treatment failure did not differ between groups (short - 11.2% vs prolonged - 9.4%; OR, 1.22; 95% CI, 0.75-1.98). 37 total children experienced a UTI recurrence within 30 days. Of those, 6 of 15 (40%) in the short-course group and 14 of 22 (64%) in the prolonged-course group grew an organism with increased antibiotic resistance from prior (OR, 0.36; 95% CI, 0.09-1.43), though this did not meet statistical significance.
Key Strengths: The authors increased generalizability by including all patients with pyelonephritis, including frequently excluded populations such as patients who were critically ill, immunocompromised, or had preexisting urologic abnormalities. To help account for treatment bias, the authors used these characteristics to generate a cohort based on probability of treatment-weighted propensity scores. Finally, data integrity was strengthened by identifying patients using a clinical definition of pyelonephritis confirmed by manual chart review rather than relying on diagnosis codes.
Limitations: As a retrospective study, these results are subject to bias. Subjects were from a single hospital system and may not be generalizable. The authors only had access to follow-up data if subjects sought care within the same health system. Also, a rather broad definition of pyelonephritis may have captured subjects without pyelonephritis.
Main Takeaway: A cohort of pediatric patients with pyelonephritis who were treated with a shorter course of antibiotics (<10 days, median 8 days) had similar rates of treatment failure to those treated with longer courses (≥10 days, median 11 days).
Impact on Practice: Similar to adult literature, pediatric patients with pyelonephritis may be adequately treated with a shorter antibiotic course. This may help combat the emergence of drug-resistant organisms.
Fellow: Nathan Money, DO, Pediatric Hospital Medicine Fellow, Baylor College of Medicine, Texas Children’s Hospital
Fellowship Accomplishments/Current Research: Led and published project titled “2019 Update on Pediatric Medical Overuse: A Systematic Review” in JAMA Pediatrics. Currently leading a study examining model of care variation for patients admitted with Kawasaki Disease using data from the PHIS database augmented by chart review. Selected as the inaugural fellow speaker for the Pediatric Update at this year’s SHM meeting (to be presented online).
Goals/Plans for the Future: I hope to promote personal and divisional scholarly activity throughout my career, with a focus on reducing medical overuse and promoting high-value care. I have accepted a position at Utah Valley Hospital, a community hospital affiliated with Primary Children’s Hospital in Utah.
Fun Fact: I have 3 children, ages 4, 2, and 3 months old.
Fellowship Accomplishments/Current Research: Led and published project titled “2019 Update on Pediatric Medical Overuse: A Systematic Review” in JAMA Pediatrics. Currently leading a study examining model of care variation for patients admitted with Kawasaki Disease using data from the PHIS database augmented by chart review. Selected as the inaugural fellow speaker for the Pediatric Update at this year’s SHM meeting (to be presented online).
Goals/Plans for the Future: I hope to promote personal and divisional scholarly activity throughout my career, with a focus on reducing medical overuse and promoting high-value care. I have accepted a position at Utah Valley Hospital, a community hospital affiliated with Primary Children’s Hospital in Utah.
Fun Fact: I have 3 children, ages 4, 2, and 3 months old.
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