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[Management of urinary tract infections in children. Evaluation of clinical practice]
S Bontemps1, M Lagrée2, R Dessein3
1Urgences pédiatriques et maladies infectieuses, université Lille Nord-de-France, hôpital R.-Salengro, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France; Faculté de médecine, université Lille-2, UDSL, 59000 Lille, France.
Insights
Pediatric urinary tract infection (UTI) management adherence was high initially but improved with urine culture review. Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae-related UTIs remain rare.
Area of Science:
- Pediatrics
- Infectious Diseases
- Antimicrobial Stewardship
Context:
- Urinary tract infections (UTIs) are common in children.
- The rise of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae poses challenges to UTI treatment.
- Evaluating adherence to institutional protocols is crucial for optimizing pediatric UTI care.
Purpose:
- To assess the rate of adherence to institutional protocols for managing pediatric UTIs.
- To identify factors associated with nonadherence to UTI treatment guidelines.
- To understand the impact of ESBL-producing Enterobacteriaceae on UTI management.
Summary:
- This study analyzed 393 pediatric UTI cases, finding 95% initial protocol adherence and 80% at re-evaluation.
- Nonadherence was linked to inappropriate treatment and dual antibiotic use.
- Infants under 3 months and unconfirmed infections were risk factors for inadequate management.
Impact:
- Protocol adherence for pediatric UTIs is generally good but can be enhanced through improved re-evaluation processes.
- Current rates of ESBL-producing Enterobacteriaceae in UTIs are low and do not significantly impede management efficacy.
- Findings support refining clinical pathways for pediatric UTI treatment.
Objective:
To determine the rate of therapeutic management satisfying the institutional protocol for children with urinary tract infection (UTI) in the context of the emergence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae.
Methods:
A retrospective, single-center, observational study was carried out for 1 year (2010-2011). Data from all children admitted to the emergency department with a diagnosis of UTI were analysed. Adherence to the protocol was evaluated for the initial management and at re-evaluation with the definitive result of the urine culture. Risk factors for nonadherence were analysed.
Results:
Among the children, 393 were included. An ESBL Enterobacteriaceae-related UTI was identified in 2.2% of urine analyses. The initial therapeutic management satisfied the protocol for 95% of children and at re-evaluation for 80%. Nonadherence was related to poorly adapted treatment (59%) and an erroneous indication of dual antibiotic therapy (20%). Variables associated with the inadequacy of the initial management were age less than 3 months (adjusted OR [aOR]: 9.3; 95%CI: 3.5-24.8) and at re-evaluation age under 3 months (aOR: 12.8; 95%CI: 5.5-29.9) and an unconfirmed infection in the final urine culture (aOR: 30.8; 14.7-64.3).
Conclusion:
Adherence to the protocol was good but could be increased by a better re-evaluation procedure with the result of the urine culture. ESBL Enterobacteriaceae-related UTIs were still rare enough to influence the efficacy of management.
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