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

Q2 Medicine

Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2023-01-01 DOI:10.5863/1551-6776-28.3.241

Michelle M Lee, Leslie Briars, Kirsten H Ohler, Alan Gross, Lauren M Oliveri

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引用次数: 0

Abstract

Objective: To 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.

Methods: We 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.

Results: Of 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.

Conclusions: Pediatric 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.

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2个月至18岁儿童尿路感染的门诊抗生素处方评价

目的:了解伊利诺伊大学医院和健康科学系统(UIH)儿科患者尿路感染(UTI)的诊断和处理，重点是抗生素处方;此外，表征儿科尿路病原体模式，以帮助指导未来的经验性治疗选择。方法:我们对2014年1月1日至2018年8月31日期间在UIH急诊科或诊所就诊的年龄为2个月至≤18岁的儿科患者进行了回顾性描述性研究，这些患者的出院诊断为ICD-9或ICD-10。收集的数据包括出现症状、尿液分析、抗生素治疗方案的细节、尿液培养和敏感性结果。结果:纳入的207例患者中位年龄为5.7岁(IQR, 3.2 ~ 9.4)，女性183例(88.4%)。常见症状包括排尿困难(57%)和发烧(37%)。96.1%的病例使用经验性抗生素，最常见的是头孢地尼(42%)、头孢氨苄(22%)和磺胺甲恶唑-甲氧苄啶(14%)。收集尿培养161例(77.8%)，其中有81例的菌落形成单位大于5万个。大肠杆菌是最常见的分离菌(82.1%)，对第三代头孢菌素(97%)、呋喃妥英(95%)和磺胺甲恶唑-甲氧苄啶(84%)敏感。虽然25例尿培养未见生长，但只有4例停用抗生素。结论:有尿路感染症状的儿科患者经常经验性地开头孢地尼，这可能是一个不必要的广泛选择，因为许多大肠杆菌菌株对狭窄的药物敏感。在对尿路感染进行诊断评估时，应同时进行尿液分析和尿液培养，并对阴性培养进行更好的随访，以便可能停止使用抗生素。本研究强调了在儿科尿路感染的诊断、治疗和抗菌药物管理方面有待改进的领域。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pediatric Pharmacology and Therapeutics Medicine-Pediatrics, Perinatology and Child Health

CiteScore

2.40

自引率

0.00%

发文量

期刊介绍： The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.