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Reducing Antibiotic Duration for Uncomplicated UTI in the Pediatric Emergency Department

Gagandeep K Kooner1,2, Marissa Bass1,3, Vivek Saroha1,4

  • 1Children's Healthcare of Atlanta, Atlanta, Georgia.

Hospital Pediatrics
|March 27, 2024
PubMed

Insights

Short-duration antibiotic treatment for pediatric uncomplicated urinary tract infections (uUTI) is effective and promotes antibiotic stewardship. A quality improvement project successfully increased short-course prescriptions in an emergency department setting.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Diseases
  • Quality Improvement Science

Background:

  • Short-duration antibiotic therapy (3-5 days) for uncomplicated urinary tract infections (uUTI) in children over 24 months is as effective as longer courses.
  • This approach supports antibiotic stewardship, reducing unnecessary antibiotic exposure.
  • In a pediatric emergency department (ED), only 13% of eligible patients with uUTI received short-duration antibiotic prescriptions.

Purpose of the Study:

  • To increase the rate of short-duration antibiotic prescriptions for pediatric uUTI from 13% to over 50% within 12 months.
  • To evaluate the impact of interventions on antibiotic prescribing practices for uUTI in a pediatric ED.
  • To assess the safety of reduced antibiotic duration by monitoring patient revisits for UTI.

Main Methods:

  • A quality improvement project conducted between January 2021 and August 2022, excluding complicated UTIs.
  • Interventions included provider education, practice feedback, and electronic health record (EHR) modifications.
  • The proportion of children treated with short antibiotic durations was tracked using p-charts; antibiotic days saved were calculated; and 14-day UTI revisit rates were analyzed.

Main Results:

  • The proportion of children treated with short-duration antibiotics for uUTI increased from 13% to 91% post-intervention, exceeding the 50% target within 2 months.
  • A total of 2619 antibiotic days were saved.
  • The rate of revisits with culture-positive uUTI within 14 days was low (0.6%) and not significantly increased.

Conclusions:

  • Implementing education, feedback, and EHR changes effectively reduced antibiotic duration for pediatric uUTI in the ED.
  • This quality improvement initiative achieved its goal without compromising patient safety, evidenced by stable revisit rates.
  • The successful interventions are potentially scalable to broader age groups and other outpatient settings.
Abstract

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