Pediatric UTI: antibiotics often prescribed in ED despite negative culture

  • Alghounaim M & al.
  • Pediatr Emerg Care
  • 28 Feb 2019

  • International Clinical Digest
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Takeaway

  • Presumed pediatric urinary tract infections (UTIs) may account for a significant number of unnecessary antibiotic prescriptions in emergency department (ED) settings.

Why this matters

  • Base empiric treatment, antibiotic treatment decisions on nitrite-positive or -negative specimens with ≥1 leukocyte esterase (LE) catheter samples, ≥2 LE other samples to improve UTI diagnostic accuracy.
  • Discontinue empiric therapy upon negative cultures.
  • Standardize antimicrobial duration institutionally.

Key results

  • 183 patients, median age of 4.2 (interquartile range, 1.1-7.5) years.
  • 65.8% (119), 33.3% (61) samples collected by midstream urine, catheterization, respectively.
  • Upper, lower UTI symptoms observed in 54.1% (99), 41.5% (76) patients, respectively.
  • 98.4% (180) patients discharged on antibiotics.
  • Median antibiotics duration, 7 (7-10) days.
  • 46.4% (85) patients with negative cultures received antibiotics and no follow-up to stop.
  • LE of +2 (OR, 4.07; 95% CI, 0.88-18.87; P=.073) or +3 (OR, 3.35; P=.096) predictive of UTI in all specimens.
  • Nitrites presence was strongest UTI predictor (OR, 20.22; P<.001 a specificity of>

Study design

  • Single-center, retrospective, pediatric cohort study determining frequency of empiric antibiotic prescribing for unconfirmed/suspected UTI in the ED.
  • Funding: None disclosed.

Limitations

  • Retrospective.
  • Lack of well-documented clinical data.
  • Incongruent urinalysis and culture follow-up.
  • Missed data because of patient discharge.