Variability in Treatment of UTIs in Children With Genitourinary Anomalies in Children's Hospitals.

Objective: In children with urinary tract anomalies, febrile urinary tract infections (UTIs) are associated with increased risks of sepsis, hospitalization, and kidney injury. However, the best treatment strategies are unknown. We aimed to describe antibiotic treatment practices and outcomes for UTIs in children with urinary tract anomalies and evaluate whether variability in UTI treatment exists between hospitals.

Methods: We conducted a multicenter retrospective cohort study of children seen in emergency departments (EDs) in 6 free-standing US children's hospitals from January 1, 2017, through December 31, 2018. We included children aged 0-17 years with an anatomic or functional urinary tract anomaly and a physician diagnosis of febrile or hypothermic UTI. Outcomes included intravenous (IV) antibiotic administration practices, hospitalization rates, length of stay, and return ED visits. Multivariable logistic and linear regression were performed, adjusting for differences in patient and illness characteristics.

Results: Among the 510 children included, anomaly types, presence of home catheterization regimens, and baseline glomerular filtration rates varied between sites. In the adjusted analyses, sites differed in several treatment practices: IV antibiotic administration before ED discharge (P = .007), IV antibiotic spectrum (P = .003), IV antibiotic duration (P < .001), and hospital length of stay (P < .001). No statistically significant differences existed with bacteremia (P = .24) or intensive care stays (P = .08). Returns to the ED within 30 days did not significantly differ by site (P = .68).

Conclusions: Children's hospitals vary in their treatment of UTIs in children with urinary tract anomalies, yet ED revisits are similar across sites, highlighting the opportunity to promote high-value care in treatment of UTIs in this population.