Related Experiment Video
Updated: Oct 14, 2025
Quantifying the Effects of Antimicrobials on In vitro Biofilm Architecture using COMSTAT Software
Published on: December 14, 2020
Analysis of Community-Acquired Urinary Tract Infection Treatment in Pediatric Patients Requiring Hospitalization:
Jeremy S Stultz1,2, Natalie Francis1,2, Samantha Ketron3
1The University of Tennessee Health Science Center, Memphis, TN, USA.
Insights
First-generation cephalosporins (FGC) are appropriate for empiric treatment of pediatric urinary tract infections (UTIs), offering similar coverage to third-generation cephalosporins (TGC). Identifying factors associated with FGC nonsusceptibility can refine treatment decisions.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Urology
Background:
- Optimal treatment of pediatric urinary tract infections (UTIs) requires using the narrowest-spectrum antibiotic possible.
- Current empiric antibiotic selection for pediatric UTIs often involves broad-spectrum agents.
- There is a need to identify appropriate narrow-spectrum options and factors influencing antibiotic choice.
Purpose of the Study:
- To determine the suitability of first-generation cephalosporins (FGC) as an empiric treatment for pediatric UTIs.
- To identify factors distinguishing the need for empiric FGC versus third-generation cephalosporin (TGC) coverage.
- To identify factors associated with the use of unnecessarily broad-spectrum antibiotics for definitive UTI treatment.
Main Methods:
- Retrospective chart review of pediatric patients diagnosed with UTIs and treated between 2013 and 2015.
- Multivariable logistic regression analysis was employed to identify independent factors associated with empiric and definitive antibiotic treatment outcomes.
- Analysis focused on organism susceptibility, empiric coverage, and de-escalation rates.
Main Results:
- First-generation cephalosporin (FGC) empiric coverage for cultured organisms was only 5.4% lower than third-generation cephalosporin (TGC) coverage.
- Factors associated with FGC nonsusceptibility included adolescent age, uncircumcised males, Hispanic ethnicity, and recent hospitalization.
- Unnecessarily broad-spectrum definitive treatment was linked to higher urine and serum white blood cell counts and limited narrow-spectrum options.
Conclusions:
- First-generation cephalosporins (FGC) are an appropriate narrow-spectrum empiric choice for pediatric urinary tract infections (UTIs).
- Specific patient factors can help stratify decisions regarding empiric antibiotic selection.
- Educational interventions targeting factors associated with broad-spectrum definitive treatment are warranted.
Abstract:
Background: The most narrow-spectrum antibiotic possible should be used for empiric and definitive treatment of pediatric urinary tract infections (UTIs). Objectives: The objectives of this study were to determine an appropriate narrow-spectrum antibiotic for empiric UTI treatment, factors differentiating empiric first-generation cephalosporin (FGC) versus third-generation cephalosporin (TGC) coverage, and factors associated with unnecessarily broad-spectrum definitive antibiotic treatment. Methods: This was a retrospective chart review of children admitted from 2013 to 2015 who were diagnosed with a UTI and received treatment. Multivariable logistic regression assessed independent factors associated with our outcomes. Results: Of 568 diagnosed UTIs, 88.6% received empiric TGC treatment. Empiric coverage among cultured organisms was only 5.4% lower in FGC versus TGC. Adolescent age group (odds ratio [OR] = 8.83, 95% confidence interval [CI] = 1.47-53.11), uncircumcised males (OR = 4.52, 95% CI = 1.27-16.08), Hispanic ethnicity (OR = 4.37, 95% CI = 1.14-16.82), and hospitalization within the preceding 3 months (OR = 4.73, 95% CI = 1.38-16.23) were associated with FGC nonsusceptibility among TGC susceptible Enterobacteriaceae pathogens. De-escalation occurred in 55.8% of diagnosed UTIs eligible for de-escalation at discharge. Urine white blood cell (WBC) count >5 (OR = 2.89, 95% CI = 1.14-7.21), serum WBC count (OR = 1.04, 95% CI = 1.01-1.07), and having only one narrow-spectrum treatment option (OR = 5.1, 95% CI = 2.43-10.66) were associated with unnecessarily broad-spectrum definitive treatment. Conclusion and Relevance: FGC would be an appropriate narrow-spectrum empiric agent for UTIs at our institution. The factors associated with FGC nonsusceptibility can further stratify empiric treatment decisions. The factors associated with unnecessarily broad-spectrum definitive treatment illustrate areas for educational efforts and future research regarding UTI treatment.
More Related Videos
07:34Isolation of Single Intracellular Bacterial Communities Generated from a Murine Model of Urinary Tract Infection for Downstream Single-cell Analysis
Published on: April 16, 2019
09:17A Robust Pneumonia Model in Immunocompetent Rodents to Evaluate Antibacterial Efficacy against S. pneumoniae, H. influenzae, K. pneumoniae, P. aeruginosa or A. baumannii
Published on: January 2, 2017
Related Concept Videos
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:17Urinary Tract Infection IV: Nursing Management
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:26Urinary Tract Infection I: Introduction