A randomized trial conducted in Italy showed that a 5-day course of antibiotics in children with febrile urinary tract infection (fUTI) was noninferior to 10 days, researchers reported this week in Pediatrics.

In the multicenter trial, a team led by investigators from the University of Trieste randomly assigned children aged 3 months to 5 years with noncomplicated fUTI to receive oral amoxicillin-clavulanate in three divided doses for 5 days or the standard 10 days. The primary endpoint was the recurrence of a UTI within 30 days after treatment. Secondary endpoints included clinical recovery at end of treatment, adverse drug-related events, and resistance to amoxicillin-clavulanate or other antibiotics when a recurrent UTI occurred. The noninferiority threshold was 5 percentage points.

Lower UTI recurrence in the 5-day group

Of the 175 children assessed for eligibility, 142 underwent randomization, with 72 assigned to the 5-day arm and 70 to the 10-day arm. The recurrence rate of all UTIs (febrile and non-febrile) within 30 days from the end of therapy was 2.8% in the short group and 14.3% in the standard group, for a between-group difference of –11.51 percentage points (95% confidence interval [CI], –20.52 to –2.47). The recurrence rate of fUTI within 30 days from the end of therapy was 1.4% in the short group and 5.7% in the standard group (difference, –4.33 percentage points; 95% CI, –10.40 to 1.75).

Resolution of signs and symptoms occurred in 97.2% of cases in the short group, and 92.9% in the standard group. The frequency of adverse events was 1.4% in the short group, with none reported in the standard group. The emergence of antibiotic resistance to amoxicillin-clavulanate or other antibiotics did not differ between the two treatment groups.

"To our knowledge, this is the first study in the literature concerning brief therapy in UTIs," the study authors wrote. "Further trials are needed to confirm these results."

A new study published in JAMA suggests that US hospitals owned by private equity firms suffer more hospital-based adverse events, including falls, central line blood infections, and surgical-site infections.

More than 200 US hospitals are run by such firms, which critics worry place profits and quick sales to liquidate debt above patient care.

The study compared outcomes among 662,095 hospitalizations at 51 private equity–acquired hospitals and 4,160,720 hospitalizations at 259 matched control hospitals using 100% Medicare Part A claims data. Events were assessed 3 years before to 3 years after private equity acquisition.

They found that Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions. This increase in hospital-acquired conditions was driven by a 27.3% increase in falls and a 37.7% increase in central line–associated bloodstream infections.

Surgical site infections doubled from 10.8 to 21.6 per 10,000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume.

"Surgical site infections doubled from 10.8 to 21.6 per 10,000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume," the authors said. "Meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations.”

The authors said their findings validate concerns over private equity firms providing substandard patient care.