Departments of Pediatrics.
Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina, Charleston, South Carolina.
Hosp Pediatr. 2024 Nov 1;14(11):909-918. doi: 10.1542/hpeds.2024-007756.
We examined local prescribing patterns across the entire treatment course for children treated for uncomplicated urinary tract infection (UTI) to determine opportunities for antibiotic stewardship initiatives.
We conducted a retrospective review of emergency department and inpatient encounters for febrile and afebrile UTI in a children's hospital from 2021 to 2022. An antibiotic spectrum ranking was established, and providers' choices were assessed for appropriateness on the basis of the individuals' urine culture (UCx). Groups were stratified by fever presence and compared using χ2, Fisher's exact, and Mann-Whitney U tests.
Of 172 encounters (83% emergency department), 99 (58%) had a positive UCx. Eighty (80%) grew Escherichia coli, with 67 (84%) being susceptible to cefazolin (minimum inhibitory concentration ≤16 mg/L). There were 229 antibiotic regimens and 39 (17%) were appropriate. Inappropriate antibiotic choices included unnecessary use of broad-spectrum antibiotics and misdiagnosed UTI. Grouping by encounter, at least 1 dose of a third cephalosporin was given in 51% of encounters, and 80% of these received it unnecessarily because of UTI misdiagnosis or suitability of a narrower-spectrum antibiotic. The median prescribed antibiotic duration was 7 days (interquartile range 7-10). Of 73 encounters with UCx growing mixed flora or a nonuropathogen, only 29 (40%) had antibiotics discontinued. Confirmed UTI was associated with fever and nitrite positivity.
Our study revealed high prevalence of inappropriate antibiotics, particularly unnecessary prescribing of third cephalosporin, prescriptions not supported by laboratory data, and prolonged treatment courses. Our results identify factors that can be used to support UTI treatment pathways and ensure antibiotic stewardship.
我们考察了在治疗单纯性尿路感染（UTI）患儿的整个治疗过程中，各地的处方模式，以确定抗生素管理计划的实施机会。
我们对一家儿童医院 2021 年至 2022 年期间发热和非发热性 UTI 的急诊和住院患者进行了回顾性研究。建立了抗生素谱排名，并根据个体的尿培养（UCx）评估了提供者选择的适当性。根据发热的存在对组进行分层，并使用 χ2、Fisher 精确检验和 Mann-Whitney U 检验进行比较。
在 172 次就诊（83%为急诊）中，99 次（58%）UCx 阳性。80 株（80%）为大肠埃希菌，其中 67 株（84%）对头孢唑林敏感（最低抑菌浓度≤16mg/L）。共有 229 种抗生素方案，其中 39 种（17%）是适当的。不合理的抗生素选择包括不必要地使用广谱抗生素和误诊 UTI。按就诊分组，51%的就诊至少给予了一剂第三代头孢菌素，其中 80%的就诊是不必要的，因为 UTI 误诊或窄谱抗生素更合适。中位数规定的抗生素疗程为 7 天（四分位间距 7-10 天）。在 73 次 UCx 生长混合菌群或非尿路病原体的就诊中，仅 29 次（40%）停止使用抗生素。确诊 UTI 与发热和亚硝酸盐阳性有关。
我们的研究表明，抗生素的不合理使用非常普遍，尤其是不必要地使用第三代头孢菌素、处方未得到实验室数据支持以及治疗疗程延长。我们的结果确定了可用于支持 UTI 治疗途径和确保抗生素管理的因素。
