University of Pittsburgh School of Medicine, Pittsburgh, PA; Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
University of Pittsburgh School of Medicine, Pittsburgh, PA; Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
J Pediatr. 2019 Feb;205:126-129. doi: 10.1016/j.jpeds.2018.09.029. Epub 2018 Oct 16.
To identify factors associated with delayed antimicrobial treatment in febrile children with urinary tract infection (UTI).
We reviewed data from 802 children with UTI enrolled in 2 previously conducted prospective studies (Randomized Intervention for Children with Vesicoureteral Reflux and Careful Urinary Tract Infection Evaluation) and extracted data on possible predictors of delayed treatment including age, sex, history of UTI, ethnicity, race, primary caregiver's education level, insurance, and income. We used univariate and multivariable analyses to investigate the relationship between these predictors and treatment delay.
We included 660 febrile patients with a mean age of 17.0 months old. Older age and commercial insurance were associated with delayed treatment on univariate analysis. Compared with younger children, treatment was delayed by an average of 26.2 hours in children ≥12 months of age. This relationship remained significant on multivariable analysis. Treatment also was delayed by an average of 12.6 hours in patients with commercial insurance. Race, ethnicity, primary caregiver's education level, and income were not associated with delayed treatment.
Older age was a consistent predictor of delayed antimicrobial treatment. Delays in the initiation of antimicrobial therapy for UTI has previously been associated with renal scarring. Educating parents with older children regarding the management of fever as well as providers regarding prompt evaluation and management may help to reduce renal scarring.
确定与发热性尿路感染（UTI）儿童抗菌治疗延迟相关的因素。
我们回顾了先前进行的两项前瞻性研究（随机干预儿童膀胱输尿管反流和仔细尿路感染评估）中 802 例 UTI 患儿的数据，并提取了可能与治疗延迟相关的预测因素数据，包括年龄、性别、UTI 史、种族、民族、主要照顾者的教育程度、保险和收入。我们使用单变量和多变量分析来研究这些预测因素与治疗延迟之间的关系。
我们纳入了 660 例发热性患者，平均年龄为 17.0 个月。单变量分析显示，年龄较大和商业保险与治疗延迟有关。与年龄较小的儿童相比，年龄≥12 个月的儿童的治疗平均延迟 26.2 小时。这种关系在多变量分析中仍然显著。商业保险患者的治疗也平均延迟了 12.6 小时。种族、民族、主要照顾者的教育程度和收入与治疗延迟无关。
年龄较大是抗菌治疗延迟的一致预测因素。先前的研究表明，UTI 抗菌治疗的延迟与肾瘢痕形成有关。对年龄较大的儿童的父母进行有关发热管理的教育，以及对提供者进行及时评估和管理的教育，可能有助于减少肾瘢痕形成。
