Epidemiologic Trends in Pediatric Urinary Tract Infections Among United States Emergency Departments from 2016-2023.

Abstract

Introduction: Urinary tract infections are a common consideration among pediatric patients with fever. With rising resistance rates and increased focus on antibiotic stewardship, there is a need to better understand the current management. This study reports the incidence and antibiotic distribution among a nationwide cohort of Emergency Department (ED) patients with cystitis and pyelonephritis over an eight-year period.

Methods: We performed a cohort study from 1/1/2016-12/31/2023 using Epic Cosmos. Pediatric (<18 years) ED patients with an ICD-10 code corresponding to cystitis or pyelonephritis were included. Outcomes included total number of ED presentations, outpatient antibiotic prescriptions, and antibiotics administered in the ED for admitted patients with cystitis or pyelonephritis. Binary logistic regression models were used to measure the relationship between year and dependent variables.

Results: Among 46,774,814 total pediatric ED visits, 730,863 (1.5%) were for cystitis and 82,717 (0.18%) were for pyelonephritis. Among those admitted, the most common antibiotics were third-generation cephalosporins (cystitis:55.6%, pyelonephritis:62.3%), first-generation cephalosporins (cystitis:13.8%, pyelonephritis:13.7%), and ampicillin (cystitis:10.8%, pyelonephritis:6.6%). First-generation cephalosporin use rose over time, while ampicillin and ciprofloxacin use declined. Among discharged patients, the most common antibiotics were first-generation cephalosporins (cystitis:43.1%, pyelonephritis:33.7%), third-generation cephalosporins (cystitis:20.8%, pyelonephritis:25.8%), and trimethoprim-sulfamethoxazole (cystitis:13.5%, pyelonephritis:11.8%). First-generation cephalosporin use rose over time, while trimethoprim-sulfamethoxazole and ciprofloxacin use declined. Among those with cystitis specifically, third-generation cephalosporins declined over time.

Conclusion: Cystitis and pyelonephritis remain common ED presentations, representing nearly 2% of all pediatric ED visits, and there have been notable shifts in the antibiotic selection over time. Understanding the current epidemiology can inform public health planning and antibiotic stewardship in the ED.