Evaluation of Outpatient Antibiotic Prescribing for Urinary Tract Infection in Pediatric Patients Ages 2 Months to 18 Years

Abstract

OBJECTIVETo characterize the diagnosis and management of urinary tract infection (UTI) in pediatric patients at the University of Illinois Hospital and Health Sciences System (UIH), with an emphasis on antibiotic prescribing; in addition, to characterize pediatric uropathogen patterns to help guide future empiric therapy choices.METHODSWe used a retrospective, descriptive study of pediatric patients ages 2 months to ≤18 years seen at the UIH emergency department or clinic from January 1, 2014, to August 31, 2018, with ICD-9 or ICD-10 discharge diagnosis of UTI. Data collected included presenting symptoms, urinalysis, details of antibiotic regimens, urine culture, and susceptibility results.RESULTSOf the 207 patients included, the median age was 5.7 years (IQR, 3.2–9.4), and 183 patients (88.4%) were female. Common symptoms included dysuria (57%) and fever (37%). Empiric antibiotics were p-rescribed in 96.1% of cases, most commonly cefdinir (42%), cephalexin (22%), and sulfamethoxazole-trimethoprim (14%). Urine cultures were collected in 161 patients (77.8%), with 81 growing >50,000 colony-forming units bacteria. Escherichia coli was the most commonly isolated organism (82.1%), showing susceptibility to third-generation cephalosporins (97%), nitrofurantoin (95%), and sulfamethoxazole-trimethoprim (84%). Although 25 urine cultures showed no growth, antibiotics were discontinued in only 4 cases.CONCLUSIONSPediatric patients with UTI symptoms were often empirically prescribed cefdinir, possibly an unnecessarily broad choice because many E coli isolates were susceptible to narrower agents. Both urinalysis and urine cultures should be obtained during the diagnostic evaluation of UTI, with better follow-up of negative cultures to potentially discontinue antibiotics. This study highlights areas for improvement in the diagnosis, treatment, and antimicrobial stewardship in pediatric UTI.