- 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.
- 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>
- Single-center, retrospective, pediatric cohort study determining frequency of empiric antibiotic prescribing for unconfirmed/suspected UTI in the ED.
- Funding: None disclosed.
- Lack of well-documented clinical data.
- Incongruent urinalysis and culture follow-up.
- Missed data because of patient discharge.