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Compliance with guidelines for the medical care of first urinary tract infections in infants: a population-based
Adam L Cohen1, Frederick P Rivara, Robert Davis
1Department of Pediatrics, University of Washington, 6200 NE 74th St, Suite 210, Seattle, WA 98115-8160, USA. alcohen@u.washington.edu
Insights
Less than half of infants with a urinary tract infection (UTI) received recommended medical care. Hospitalization was linked to higher rates of recommended imaging for these pediatric UTIs.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Health Services Research
Background:
- Population-based studies on adherence to practice parameters for infant urinary tract infections (UTIs) are lacking.
- Understanding care patterns for first UTIs in infants is crucial for optimizing health outcomes.
Purpose of the Study:
- To describe the medical care received by children in their first year of life following a first urinary tract infection (UTI).
- To assess adherence to American Academy of Pediatrics guidelines for pediatric UTIs.
Main Methods:
- Retrospective cohort study utilizing Washington State Medicaid data.
- Analysis of children with a first UTI in their first year of life.
- Evaluation of recommended care including timely anatomic and reflux imaging, and antimicrobial prophylaxis.
Main Results:
- Fewer than 50% of infants with a first UTI received recommended medical care.
- Hospitalization for a first UTI was associated with significantly higher rates of recommended anatomic imaging (RR: 1.38) and reflux imaging (RR: 1.62).
Conclusions:
- There is poor compliance with guideline-recommended care for infant urinary tract infections within a Medicaid population.
- Increased focus on outpatient imaging is warranted given the trend toward outpatient management of pediatric UTIs.
Background:
No population-based studies have examined the degree to which practice parameters are followed for urinary tract infections in infants.
Objective:
To describe the medical care of children in their first year of life after a first urinary tract infection.
Methods:
Using Washington State Medicaid data, we conducted a retrospective cohort study of children with a urinary tract infection during their first year of life to determine how many of these children received recommended care based on the most recent guidelines from the American Academy of Pediatrics. Recommended care included timely anatomic imaging, timely imaging for reflux, and adequate antimicrobial prophylaxis. Multivariate logistic-regression models were used to evaluate if hospitalization for first urinary tract infection, young age at time of diagnosis, gender, race, primary language of parents, having a managed care plan, and rural location of household residence were associated with recommended care.
Results:
Less than half of all children diagnosed with a urinary tract infection in their first year of life received the recommended medical care. Children who were hospitalized for their first urinary tract infection were significantly more likely than children who were not hospitalized to receive anatomic imaging (relative risk [RR]: 1.38; 95% confidence interval [CI]: 1.20-1.57) and imaging for reflux (RR: 1.62; 95% CI: 1.34-1.90).
Conclusions:
There is poor compliance with guideline-recommended care for first urinary tract infections in infants in a Medicaid population. Given the trend toward increased outpatient management of urinary tract infections, increased attention to outpatient imaging may be warranted.
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