29 - Measuring Adherence to First-Line Antimicrobial Treatment for Presumed Urinary Tract Infections in the Pediatric Emergency Department

Poster Number: 29
Publication Number: 29.11

Malek Mazzawi, Children's National Hospital, Washington, DC, United States; Madhuri Uppuluri, Children's National Health System, Reston, VA, United States; Kenneth McKinley, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Deena Berkowitz, Children's National Health System, silver spring, MD, United States; Kristen Breslin, Children's National Health System, Washington, DC, United States

Background: Urinary tract infections (UTIs) are a common diagnosis among pediatric patients seen in the emergency department (ED). UTIs are frequently treated with a wide range of antimicrobials, which can lead to increased antibiotic resistance. While prior studies have assessed antibiotic stewardship for UTIs in adults, limited work has been done to study appropriate antibiotic prescribing for pediatric patients diagnosed with UTIs in the ED.

Objective:

The primary aim of this study was to assess adherence of antimicrobial prescribing to current recommendations for uncomplicated UTIs treated in the pediatric ED. The secondary aim was to identify characteristics that made adherence to recommendations more likely.




Design/Methods: This study was a single center, retrospective medical record review of oral antibiotics prescribed for presumed uncomplicated UTIs for children less than 19 years old, between January 2018 and March 2021, at a large academic pediatric ED. We included patients with ICD-10 codes for UTIs, triaged as Emergency Severity Index (ESI) Level 4 and 5, who were ultimately discharged from the ED. Patients with concurrent diagnoses of other bacterial infections and those without antibiotic prescriptions were excluded. The determination of antibiotic appropriateness was based on hospital guidelines using the local antibiogram. Cephalexin and cefprozil were considered appropriate for children < 12 years, and cephalexin and nitrofurantoin for children 12 years or older. We used χ2 test and multivariable logistic regression to analyze variables associated with appropriate prescribing.

Results: A total of 1461 eligible encounters were included, with 1060 (72.6%) prescribed antibiotics considered inappropriate by hospital guidelines. Among those patients, the vast majority (88%) were prescribed cefdinir (Table 1). For patient characteristics, older age was associated with appropriate prescribing and Hispanic/Latino race was associated with inappropriate. Encounters involving a resident or physician assistant were more likely to result in prescriptions for appropriate antibiotics (Table 2).

Conclusion(s): Despite availability of a local antibiogram on the hospital intranet and recommendations embedded in the electronic health record, most pediatric ED encounters involving uncomplicated UTIs resulted in prescriptions for broader spectrum antibiotics than recommended. Future research should consider active provider education as part of ongoing quality improvement efforts.