Local Trends in the Evaluation and Treatment of Urinary Tract Infections and Vesicoureteral Reflux in Children.

INTRODUCTION

The management of urinary tract infection in children has changed in the last decade due to worries about antibiotic overuse, and the trauma and radiation of voiding cystourethrograms. We examined whether there has been a change in the management of pediatric urinary tract infection in our practice.

METHODS

We reviewed billing records from 2005 to 2013 to determine the number of voiding cystourethrograms performed as well as the number of operations (open and endoscopic) for vesicoureteral reflux. We also determined the number of patients seen in the office for urinary tract infection or vesicoureteral reflux and hospital admissions for urinary tract infection or pyelonephritis.

RESULTS

There was a dramatic decrease in the number of voiding cystourethrograms performed from 907 in 2005 to 216 in 2013. The number of operations for vesicoureteral reflux increased to a peak of 73 in 2007 and decreased to 17 in 2013. Office visits for urinary tract infection or vesicoureteral reflux were unchanged from 2006 to 2013 (602 and 470, respectively). Pediatric hospitalizations for urinary tract infection trended only slightly upward from 2005 to 2013 (71 and 84, respectively).

CONCLUSION

Our results demonstrate a marked decrease in the diagnosis and treatment of vesicoureteral reflux in the last decade with no significant change in the number of patients seen for urinary tract infection. If confirmed nationally, this has major clinical, educational and health care quality improvement implications.