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Quality indicators for appropriate antibiotic prescribing in urinary tract infections in children
Konstantinos Vazouras1, Charlotte Jackson2, Laura Folgori3
1Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle Upon Tyne, UK.
Insights
This study highlights significant issues in pediatric antibiotic prescribing for urinary tract infections (UTIs), revealing opportunities to reduce unnecessary medication use in children with UTIs.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Quality improvement in healthcare
Background:
- Urinary tract infections (UTIs) are common in children, necessitating appropriate antibiotic prescribing.
- Current prescribing practices for pediatric UTIs require evaluation to ensure optimal patient outcomes and combat antimicrobial resistance.
Approach:
- Developed and applied 12 quality indicators for pediatric UTI prescribing based on literature review.
- Collected and analyzed prescribing, clinical, and microbiological data from electronic health records of children with UTIs.
Key Points:
- A wide range of antibiotics were used, with broad-spectrum agents prescribed in 33.5% of cases despite low multi-drug resistance.
- Over 60% of patients received empiric combination therapy, with missed de-escalation opportunities in 37.8%.
- 25.7% of patients did not meet criteria for treatment, and 46.9% of prophylaxis prescriptions were potentially avoidable.
Conclusions:
- Substantial improvements are needed in antimicrobial prescribing for pediatric UTIs.
- The developed quality indicators can guide efforts to reduce unnecessary antibiotic exposure in children with UTIs.
Background:
The aim of this study was to define a set of urinary tract infections (UTIs)-specific quality indicators for appropriate prescribing in children and evaluate clinical practices in a district general hospital in Greece.
Methods:
The UTIs-specific quality indicators were informed by a review of the existing literature. Quality indicators were selected to describe the overall antibiotics use, prescribing patterns and UTIs clinical management regarding treatment and prophylaxis in a cohort of children admitted with a UTI. Microbiological, clinical and prescribing data about dosing, duration and route of administration were collected from the patients' electronic health records.
Results:
Twelve quality indicators were adapted or developed for prescribing in childhood UTIs. A broad variety of antibiotics were prescribed for UTIs, with a drug utilization (DU) 90% rate of 6 and 9 different antibiotics for febrile and afebrile UTIs, respectively. Despite the low incidence of multi-drug resistant UTIs in the study period (9/261, 3.4%), broad-spectrum antibiotics were prescribed in 33.5% (164/490) of prescriptions. A total of 62.8% (164/261) of patients were started on empiric combined therapies, while opportunities to de-escalate were missed in 37.8% (62/164) of them. One quarter (67/261, 25.7%) of patients did not fulfil the criteria for receiving treatment, while nearly half of those prescribed prophylaxis (82/175, 46.9%) could have avoided having a prophylaxis prescription.
Conclusions:
Our study identified substantial gaps for improvement in antimicrobial prescribing for UTIs in children. The application of the proposed quality indicators could help to limit unnecessary antibiotics use in children with UTI.
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