Utilizing Clinical Decision Support in the Treatment of Urinary Tract Infection across a Large Pediatric Primary Care...

Area of Science:

• Pediatric infectious diseases
• Antimicrobial stewardship
• Clinical informatics

Background:

• Urinary tract infections (UTIs) are common in children, often treated empirically.
• Antimicrobial resistance is a growing global health threat, necessitating judicious antibiotic use.
• Narrow-spectrum antibiotic selection is crucial for effective UTI management and resistance mitigation.

Purpose of the Study:

• To evaluate the impact of a clinical decision support tool on antibiotic prescribing for pediatric UTIs.
• To promote the use of guideline-recommended, narrow-spectrum first-line therapies.
• To reduce reliance on antibiotics with high local resistance rates.

Main Methods:

• An antimicrobial stewardship committee developed a UTI management guideline and standardized order set.
• The order set provided clinical decision support for primary care providers.
• Prescription data for UTIs were tracked using control charts from March 2018 to March 2020.

Main Results:

• Cephalexin, the recommended first-line therapy, saw utilization increase from 27.5% to 74.8%.
• Trimethoprim-sulfamethoxazole use decreased from 31.8% to 8.1% due to high resistance.
• Prescribing patterns favoring recommended therapies were sustained post-intervention.

Conclusions:

• Standardized order sets integrated with clinical decision support effectively improve first-line antimicrobial selection for pediatric UTIs.
• This approach offers a sustainable method for enhancing antimicrobial stewardship in pediatric care.
• The findings support the broader implementation of such tools to combat antimicrobial resistance.