Predictors of long length of stay in infants hospitalized with urinary tract infection - Abstract

OBJECTIVE: Urinary tract infection (UTI) is the most common serious bacterial infection in infants.

To use resources optimally, factors contributing to costs through length of stay (LOS) must be identified. This study sought to identify clinical and health system factors associated with long LOS in infants with UTI.

METHODS: Using a case-control design, we included infants < 6 months old hospitalized with UTI. Cases had LOS ≥96 hours; controls had LOS < 96 hours. Clinical and health system variables were extracted from medical records. Cases and controls were compared by using comparative statistics and multiple logistic regression analysis.

RESULTS: Cases (n = 71) and controls (n = 71) did not differ by gender; cases were more likely to be younger (4.2 vs 7.1 weeks, P = .04), born preterm (13% vs 3%, P = .03), have known genitourinary disease (17% vs 4%, P = .01), an ultrasound (85% vs 68%, P = .02) or voiding cystourethrogram (VCUG) (61% vs 34%, P = .001) ordered, longer wait for VCUG (53 vs 27 hours, P = .002), consult requested (54% vs 10%, P < .001), and longer duration of intravenous (IV) antibiotics (125 vs 62 hours, P < .001). Multiple logistic regression demonstrated that cases were more likely to be premature (odds ratio [OR] 7.6), have known genitourinary disease (OR 7.3), and have VCUG ordered in the hospital (OR 4.5).

CONCLUSIONS: Infants who are older, are born full term, have no genitourinary disease, receive shorter courses of IV antibiotics, and do not have a VCUG ordered have shorter stays and may be eligible for a short-stay unit. Earlier transition to oral antibiotics and delayed ordering of a VCUG may decrease LOS.

Written by:
McMullen JA, Mahant S, DeGroot JM, Stephens D, Parkin PC.   Are you the author?
Undergraduate Medical Education Doctor of Medicine Program; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, and Department of Paediatrics, Faculty of Medicine Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Clinical Research Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, Toronto, Ontario, Canada.  

Reference: Hosp Pediatr. 2014 Sep;4(5):291-7.
doi: 10.1542/hpeds.2014-0020

PubMed Abstract
PMID: 25318111 Infections Section